Manager Care Management/HMS RN FULLY BILINGUAL with supervisory and Clinical exp San Juan PR

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Job Information

Humana

Manager, Care Management/HMS (RN FULLY BILINGUAL with supervisory and Clinical exp) San Juan, PR

in

San Juan

Puerto Rico

Description

The Manager, Care Management leads teams of nurses and responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

Location: Remote Puerto Rico only

The Manager, Care Management oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Responsibilities

The Manager, Care Management uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting home health criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for our members. In this role you will:

Support and collaborate with the Retail Medical Directors, Value Based/Innovative Home Care Director, Strategy Advancement Advisor, Resolution team, UM team, and internal/external partners

Research operational issues as reported by the Operation team, Medical Director team, and Quality Assurance team

Identify opportunities to improve operational processes and develop new processes for expansion markets

Ideation: Explore Pro-active opportunities, design solutions, develop Corrective Action Plans

Outcome Analysis: Research to seek answers to relevant clinical, operational, & financial questions, and identify areas for improvement.

Monitor performance and address areas of concern

Analysis of data and support strategy development based on findings

Supervise 16-18 Direct Reports, which include Telephonic Health Care Managers

Required Qualifications

BSN

Active Registered Nurse (RN) license

5 or more years of clinical experience

2 or more years of management and/or supervisory experience

Affiliated with the CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico) IF you have an Active RN license in FL, USA, this is not a mandatory requirement

If you do not have an active FL RN license:

You need to have 2 consecutive years actively working as a Register Nurse of the preceding 3 years (no gaps in employment) and apply for FL RN license endorsement as soon as employment offer is accepted. OR,

Must have the NCLEX exam that can be used in the state of Florida

Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. Prior to being selected for the position, you will be required to take a Language proficiency Assessment in English/Spanish.

Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint

Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work

Must provide a high speed DSL or cable modem for a home office. A minimum standard speed for optimal performance of 25x10 (25mbs download x 10mbs upload) is required

Preferred Qualifications

Bachelor's degree or advanced degree in nursing or business health field

Proficiency in analyzing and interpreting data trends

Previous experience working in a managed care field

5 or more years of previous management/supervisor level experience

Additional Information

Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com