RN Manager Care Management Maternal - Child Health - Louisiana Medicaid

Profile

Description

Humana Healthy Horizons in Louisiana is seeking a RN, Manager of Care Management to lead our Maternal-Child health care management operations and staff for the Moms First program, to ensure timely and culturally-competent delivery of care, services, and supports in compliance with our Louisiana Department of Health contractual requirements and industry best practices.

Responsibilities

Essential Functions and Responsibilities:

Supervises care management personnel and oversee all care management functions, including assessment, care planning, and care coordination.

Leads development of care management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.

Collaborates with internal departments, providers, and community partners to support the delivery of high-quality case management services, including introducing innovative approaches to care coordination.

Oversees the processes for comprehensive enrollee assessments to identify their individual needs.

Monitors and maintains staffing levels to meet care and service quality objectives.

Supports orientation and training of staff.

Conducts timely evaluations of direct reports and provide regular opportunities for professional development.

Influences and assists corporate leadership in strategic planning to improve effectiveness of care and disease management programs for Maternal-Child health.

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.

Oversee Care Management staff to ensure the following:

Utilizes a holistic, enrollee-centric approach to engage and motivate enrollees and their families through recovery and health and wellness programs.

Performs clinical intervention through the development of a care plan specific to each enrollee based on clinical judgement, changes in enrollees' health or psychosocial wellness, and identified triggers.

Communicates regularly with enrollees/families, physicians, and facilities/agencies to assure optimal quality patient care and effective operations.

Collaborates with relevant internal and external partners to coordinate seamless transitions for enrollees from inpatient settings to community-based services.

Required Qualifications

Licensed Registered Nurse (RN) in the state of Louisiana, with no disciplinary action.

Must reside in the state of Louisiana.

Minimum five (5) years of experience working in healthcare.

Minimum three (3) years of experience working in the Maternal-Child Health field.

Minimum two (2) years of management/supervisory experience.

Experience in case management.

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

This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

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 100,000/300,000/100,000 limits.

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

Bachelor's degree nursing.

Certified Case Manager (CCM).

Fluency in Spanish.

Experience serving Medicaid, Medicaid/Medicare, TANF, and/or CHIP populations.

Additional Information

Workstyle : Remote

Travel: 25% in-state travel.

Direct Reports: up to 12 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