Manager, Care Management (Physical Health)

Become a part of our caring community and help us put health first

• Oversees the assessment and evaluation of members' physical health needs and requirements to achieve and/or maintain an optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and well-being of members.
• Makes decisions related to resources, approach, and tactical operations for projects and initiatives involving own departmental area and requires cross departmental collaboration.
• Conducts briefings, and area meetings, maintains frequent contact with other managers across the department.
• Reviews processes to support contractual guidelines and adjusts accordingly.
• Collects and analyzes performance reports on care management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
• Ability to work independently under general instructions and with a team.
• Utilizes a holistic, Member-centric approach to engage and motivate Members and their families through recovery and health and wellness programs.
• Provides ongoing coaching and feedback to enhance contribution, competency, and performance.
• Maintains knowledge of Medicaid and its covered benefits and services for our membership.

Use your skills to make an impact

Required Qualifications

• Must reside in the commonwealth of Virginia or within a 40-mile radius from Virginia in a bordering state/district (Washington DC, MD, WV, KY, TN & NC).
• An active, unrestricted Registered Nurse (RN) license or Licensed Mental Health Professional (LMHP) in the Commonwealth of Virginia.
• Three (3) or more years of professional experience in Medicaid care management.
• Two (2) or more years of formal management or supervisory experience directly leading teams of professionals.
• Experience with working with adult and/or Pediatric populations with mild to complex needs.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
• Proficiency in analyzing and interpreting data trends.
• Progressive business consulting and/or operational leadership experience.
• This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
• Must be able to travel throughout the Commonwealth of Virginia.
• This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.

Preferred Qualifications

• Advanced degree in nursing or related field.
• Previous experience in a field based or a homecare-based role.
• Experience with transitions of care model and chronic illnesses.

Additional Information

• Workstyle:This is a remote position that will require you to travel.
• Travel:Up to 25% of the time to Humana Healthy Horizons office in Glen Allen, VA for collaboration and face to face meetings as well as field interactions with providers, members, and their families.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Direct Reports:Up to 15.

Work at Home Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours40

Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$84,600 - $116,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.