Associate Director Care Management

Profile

Description

Humana Healthy Horizons in Florida is seeking an Associate Director, Care Management who will lead teams of nurses and behavior health professionals responsible for care management. The Associate Director, Care Management requires a solid understanding of how organization capabilities interrelate across department(s).

Responsibilities

The Associate Director, Care Management leads and guides others in providing integrated services to and for our customers.

Oversees the day to day operations for FL LTSS Program to assigned region(s).

Provides ongoing associate coaching and feedback to enhance associate contribution, competency, and performance.

Attracts, develops, empowers and inspires talent to help Humana Healthy Horizons deliver on their contractual and business strategy.

Leads a team that can deliver LTSS services to our members with an agile approach in partnership with technology, provider relations, MMA partners and other key stakeholders while managing operational risks and contractual/regulatory risks.

Reimagines and innovates ways to create efficiencies to improve both the associate and member experience.

Achieve performance metrics for a fast paced comprehensive case management environment.

Assure contractual compliance with mandated and corporate policies regarding other departmental areas such as medical management, utilization management and case 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 well-being of members.

Decisions are typically related to identifying and resolving complex technical and operational problems within department(s).

Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent communications with team members.

Ensures the delivery of services to our members to create a seamless and easy experiences.

Leads assigned initiatives and projects to support the program and our path forward.

Required Qualification

Must reside in the Florida.

Licensed Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) in the state of Florida without restrictions.

5 or more years of managed care experience in Medicare and/or Medicaid.

3 - 5 or more years of management/leadership experience.

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

Proficiency in analyzing and interpreting data trends.

Knowledge of Medicaid Florida regulatory requirements.

Demonstrated progressive experiences with audits and corrective action plans.

Strong understanding of utilization management and utilization management trends.

Demonstrated ability to manage multiple competing priorities and delegate accordingly.

Ability to reimagine and innovate ways to create efficiencies to improve both the associate and member experience.

Strong problem-solving skills with the ability to shift focus with agility.

Strong critical-thinking skills with the ability to operate and drive progress.

Strong business acumen.

Must be able to travel throughout the state of Florida with possible overnight stays.

ACHA Level II Fingerprints required.

This role is a 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 100,000/300,000/100,000 limits.

Work at Home Requirements

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.

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates 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.

Preferred Qualifications

Reside in Region 1, 2 or 3, preferred.

BSN

Knowledge of National Committee for Quality Assurance (NCQA) standards.

Demonstrated progressive experiences with ACHA audits and corrective action plans.

Intermediate to advanced proficiency in CGX applications.

Additional information

Location: Remote.

Travel: 25% - In state travel.

Direct Reports: Up to 6 Managers.

Vaccination Statement: Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire/Montage, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Social Security Task

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

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