Humana

Manager, Care Management - Michigan

Michigan, United States

Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

Candidates must reside in Michigan and be able to travel to Wayne County or Macomb County, possess an Active Registered Nurse (RN) license or Social Work (SW) license in the state of Michigan, have a minimum of an Associate’s Degree, a minimum of 5 years of professional experience as a licensed RN or Social Worker including case and/or disease management experience, a minimum of 2 years of management experience with at least 1 year in a home care, hospice, or equivalent field-based environment, proven ability to support clinicians, proficiency in analyzing and interpreting data trends, and comprehensive knowledge of Microsoft Office applications.

Responsibilities

The Manager, Care Management oversees the assessment and evaluation of members’ needs and requirements to achieve and/or maintain optimal wellness, guides members/families toward and facilitates interaction with resources, monitors performance of staff including service performance and adherence to benchmarks, identifies members for specific case management and/or disease management activities, develops audit plans and tools, develops reporting tools, conducts briefings and area meetings, maintains frequent contact with other managers, reviews available information related to the member’s case, monitors case management activities, conducts post-discharge calls, conducts discharge planning, pre-assessment of elective admissions, onboard new staff, and is responsible for delivering care to all members served. The role also involves interviewing, hiring, coaching, evaluating, and mentoring a diverse care coordination workforce, and participating in Humana’s Driver Safety program and TB screening program.

Skills

Care Management
Team Leadership
Cross-departmental Collaboration
Performance Monitoring
Staff Development
Reporting and Data Analysis
Healthcare Operations
Member Assessment
Care Coordination
Disease Management

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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