RN Associate Director Care Management - Louisiana Medicaid

Profile

Description

Humana Healthy Horizons in Louisiana is seeking an Associate Director, Care Management who will use clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members. He/she will lead teams of nurses and behavioral health professionals responsible for care management. The Associate Director, Care Management requires a solid understanding of how organization capabilities interrelate across department(s). They will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.

Responsibilities

The Associate Director leads and guides others in providing integrated services to and for our customers. Provides ongoing associate coaching and feedback to enhance associate contribution, competency, and performance.

Oversees day to day operations and associates for Louisiana Medicaid Care Management.

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

Assure compliance with mandated and corporate policies regarding other departmental areas such as medical management, utilization management and case management.

Develop team members and creates department process flows.

Will directly lead multiple managers and highly specialized professional associates.

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.

Maintain compliance with Louisiana Department of Health (LDH), Department of Health and Human Services (DHHS), and the Centers for Medicare and Medicaid Services (CMS) guidelines and contractual requirements.

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

Required Qualifications

Must reside in the state of Louisiana.

Unrestricted Registered Nurse (RN) license in the state of Louisiana.

Minimum five (5) years of previous clinical experience.

Minimum of five (5) years of management/supervisory experience in the healthcare field.

Proficiency in analyzing and interpreting data trends.

Progressive business consulting and/or operational leadership experience.

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

Demonstrated knowledge of keyboard, Word, Excel, PowerPoint, email, and other Office software applications.

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 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.

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 or Master's Degree in nursing, public health, health administration, health policy or business.

Knowledge of Humana's internal policies, procedures and systems.

CCM (Certified Care Manager).

Experience with health promotion, coaching and wellness.

Knowledge of community health and social service agencies and additional community resources.

Additional Information

Workstyle : Hybrid Home - Works 1 - 2days/week in Humana's Baton Rouge or Metairie, LA office location and 3 - 4 days remotely.

Travel: Up to 25% of the time within the state of Louisiana.

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 comput 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