Become a part of our caring community
 

The Care Management Support Lead (MDHSS Title: Care Management Director) shall have responsibility for coordinating with and bridging gaps between the market care management team and the enterprise/ Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP) care management team(s). The Care Management Support Lead (MDHSS Title: Care Management Director) uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for Enrollees. Coordinates and communicates with stakeholders from market operations and enterprise operations including, but not limited to, Medical Directors, Quality Improvement and Population Health teams, and Long-Term Services and Supports (LTSS) teams to facilitate optimal care, treatment, and quality outcomes.

• Collaborate with plan leadership on process improvements, trends analysis, and operational efficiencies.  
• Report to plan leadership on departmental performance, challenges, opportunities, risks, and recommendations for improvements/changes.
• In collaboration with market and enterprise partners, ensures compliance with the contract, CMS and Michigan Department of Health and Human Services (MDHHS) policies, procedures, and regulations.
• Collaborates with Population Health, Quality, and Clinical Leaders to reduce barriers to care, decrease health disparities, support at-risk, underserved, and rural communities, and address HRSNs that impact Enrollees’ health and well-being.
• Review data to identify gaps in care and create solutions to address these areas.
• Fosters positive relationships with MDHHS, local and state health agencies, subcontractors, providers, hospitals, nursing and assisted living facilities, member advocacy groups, community organizations, and other stakeholders.
• Participate in Care Management collaborative meetings as required by MDHHS.

Use your skills to make an impact
 

Required Qualifications

• Michigan residency required, or willingness to relocate.
• Bachelor’s degree in nursing (BSN) or social work.
• An active, unrestricted Michigan licensed Registered Nurse (RN) or Licensed Social Worker (LSW).
• Five (5) or more years of clinical experience, to include a combination of Utilization Management Case Management, and Managed Care.
• Two (2) or more years of leadership experience.
• Knowledge of Medicare and Medicaid regulatory requirements and National Committee for Quality Assurance (NCQA) Standards.
• Intermediate to advanced proficiency in Microsoft Office programs specifically PowerPoint, Word, Excel, and Outlook.
• Previous experience with electronic case notes documentation and experience documenting in multiple computer applications/systems.

Preferred Qualifications

• Master’s degree.
• Nationally recognized Case Management certification.
• Prior experience leading integrated care team.
• Experience supporting quality improvements related to auditing results for Care Management activities.
• Intermediate to advanced healthcare financial acumen.

Additional Information

• Workstyle: This is a remote position.
• Travel: Up to 20% to meet with community partners and other care teams. May need to attend occasional onsite team engagement meetings in Humana's Michigan location.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$86,300 - $118,700 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.