Manager, Care Management

Become a part of our caring community and help us put health first

Humana Gold Plus Integrated is looking for Managers of Care Management who will lead teams of nurses, care coordinators and behavioral health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules, and goals. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.

The Manager, Care Management supervises, directs and evaluates a diverse group of health care professionals to assure effectiveness of care coordination activities.

• Leads cross-functional collaboration through regular briefings and area meetings; maintains ongoing communication with departmental managers to ensure alignment and operational efficiency.
• Identify members for specific case management and / or disease management activities.
• Monitors case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions.
• Develop system-view recommendations, reports trends and implement appropriate actions to control trends.
• Develop audit plans and tools for teams to ensure compliance with state contracts on performance metrics and to ensure member needs are met.
• Develop reporting tools in collaboration with leadership to identify clinical performance.
• Interviews, hires, mentors, evaluates, coaches and manage performance for a diverse care coordination team.
• Onboards new associates including but not limited all pre-employment human resource tasks, ordering software, hardware, supplies and support technologies.
• Monitors performance of staff including service performance and adherence to established utilization and care coordination benchmarks.

• Candidates must reside in the state of Illinois within one of the following counties OR within a 30‑mile radius of these counties in a bordering county:
  Adams, Brown, Cass, Champaign, Christian, Clark, Coles, Cumberland, De Witt, Douglas, Edgar, Ford, Fulton, Greene, Hancock, Iroquois, Jersey, Livingston, Logan, Macoupin, Mason, McDonough, McLean, Menard, Montgomery, Morgan, Moultrie, Peoria, Pike, Piatt, Schuyler, Scott, Shelby, Springfield, Tazewell, Vermilion, and Woodford.
• An active, unrestricted, Registered Nurse (RN) license, Licensed Clinical Social Worker (LCSW) OR Licensed Clinical Professional Counselor (LCPC) in the state of Illinois.
• Five (5) or more years of professional experience working in the health care industry and/or in care management.
• Two (2) or more years of leadership experience.
• Comprehensive knowledge of all Microsoft Office applications, specifically Word, Excel, and PowerPoint.
• Ability to use a variety of electronic information applications/software programs including electronic medical records.
• Proficiency in analyzing and interpreting data trends.
• This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
• Ability to travel throughout the state of Illinois.
• This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individuals must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

• Advanced degree in nursing or business health field.
• Certified Case Manager (CCM).
• Previous experience working in a managed care field.
• Five (5) or more years of previous management/supervisor level experience to include hiring, training, mentoring and coaching associates.
• Prior experience with healthcare quality measures STARS, HEDIS, etc. and/or clinical program monitoring/evaluation.
• Knowledge of community…