Clinical Business lead - Remote FL

Profile

Description

CarePlus is seeking a Clinical Business Lead who will lead teams of nurses and behavior health professionals responsible for Care Management and Utilization Management. The Clinical Business Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Clinical Business Lead will involve business strategy and development, utilizing analysis and various data to determine the best courses of action for clinical teams.

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.

Collaborates with clinical and market leadership and advises executives to develop functional strategies (often segment specific) on matters of significance.

Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision.

Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Required Qualifications

Bachelor's degree in a Health related field.

3 years of project leadership experience.

8 years of technical experience working with multiple systems and platforms.

Intermediate experience using MS Office Suite, Word, Excel, PowerPoint.

Possess a solid understanding of operations, technology, communications and processes.

Knowledge of regulatory requirements of state departments of health and/or CMS.

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. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

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. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.

Preferred Qualifications

Six-sigma experience

Knowledge of Humana systems and capabilities.

Program Management experience PMP/PMI certification.

Independent with reporting and analyzing data and value proposals.

Masters in Healthcare Administration.

Registered Nurse (RN) licensed in Florida without restrictions.

Additional Information

Typical Work Days & Hours: Monday through Friday 8:00 AM - 5:00 PM and as business needs.

Work Style: Remote/Work at Home in the state of Florida

Travel: 10% throughout Florida.

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