Associate Director Medicaid Care Management Wisconsin

Profile

Description

iCare is seeking an Associate Director, Medicaid Care Management who will lead teams of healthcare professionals responsible for care management for BadgerCare Plus and SSI Medicaid programs. The Associate Director, Medicaid Care Management role requires a solid understanding of how organization capabilities interrelate across departments.

Responsibilities

The Associate Director, Medicaid CM oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members and families toward interacting with resources appropriate for the care and wellbeing of members. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s) and could lead multiple managers or highly specialized professional associates.

Primary Responsibilities include:

Direct oversight and accountability for the Medicaid Care Management Team and outcomes.

Ensuring members participate as a key resource and partner in the care assessment and planning and that care plans are reflective of state requirements and member goals.

Ensure teams engage strong motivational interviewing skills to activate members in their own wellness and identify the areas of opportunity most important to the member.

Ensure teams operationalize the Medicaid Care Management and Population Health Model approved by leadership and regulatory agencies.

Ensure teams are validating member contact information to increase success of outreach attempts.

Effectively communicate with the Care Management Team their measurable contributions to the organizational goals.

Empower teams with measurable objectives to remain committed to quality initiatives.

Ensure team process and performance compliant with all applicable regulatory requirements through participation in proactive compliance monitoring.

Ensure the Medicaid Care Management program is continuously striving for improvement by active engagement in quality monitoring and improvement activities.

Ensures teams are completing tasks and delivering to service level agreements and/or contract specifications.

Ensures staffing and care delivery models are effectively operationalized, ensuring clinical teams are used to the highest level of their scope and licensure.

Ensure revenue is optimized to best support membership risk by ensuring teams are appropriately identifying WICT eligible members and correctly documenting care given for accurate G code billing.

Ensure revenue is optimized by partnering with Population Health and Quality Leadership to enact strategies in support of state identified performance opportunities.

Actively demonstrates Humana core values in all interactions.

Drive accountability with teams and cascade training and culture.

Maintains a positive and collaborative relationship with all market and enterprise partners.

Actively seeks growth and development opportunities provided within the company and without, committing to constant growth and evolution as a professional.

Required Qualifications

Bachelor's Degree

Four (4) or more years of previous experience working with Medicaid members.

Two (2) or more years of previous healthcare management / supervisor level experience.

Strong skills and experience in inspirational leadership, driving culture, and outcomes in alignment with organizational strategic goals.

Must have the ability to provide a high-speed DSL or cable modem for a home office.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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.

Preferred Qualifications

licensed medical professional

Additional Information

Workstyle : Hybrid Home or Hybrid Office. Hybrid Home is defined as 1 - 2 days/week in one of Humana's or iCare's WI office locations and 3 - 4 days remotely. Hybrid Office is defined as 1-2 days/week remotely and 3-4 days in one of Humana's or iCare's WI office locations.

Direct Reports: Up to 8 Managers/Associates.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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 or computer 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.

Scheduled Weekly Hours

40

Company info

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