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Humana Healthy Horizons in Virginia is seeking a Manager, Care Management (Maternal-Child Health) who will lead teams of nurses and health professionals responsible for maternal and child services care management. The Manager 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. The Maternal and Child Services Manager ensures timely and culturally competent delivery of care, services, and supports in compliance with the Virginia Department of Medical Assistance Services (DMAS) contractual requirements and industry best practices.

• 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 Commonwealth 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 Member 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.
• Participates in Care Management collaborative meetings as required by the Department of Medical Assistance (DMAS).
• 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.
• Utilizes a holistic, Member-centric approach to engage and motivate Members and their families through recovery and health and wellness programs.
• Performs clinical intervention through the development of a care plan specific to each Member based on clinical judgement, changes in Members' health or psychosocial wellness, and identified triggers.
• Communicates regularly with Members/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 Members from inpatient settings to community-based services.
• Provides ongoing coaching and feedback to enhance contribution, competency, and performance.

Use your skills to make an impact

Required Qualifications

• Must reside in the Commonwealth of Virginia
• Active RN license in the Commonwealth of Virginia, with no disciplinary action OR, LCSW, MSW, BSW, LSW, LPC
• Minimum three (3) years of experience working in the Maternal-Child health field.
• Minimum two (2) years of management/supervisory experience.
• Experience serving Medicaid, Medicaid/Medicare, TANF, and/or CHIP populations.
• Experience in case management.
• Proficiency in analyzing and interpreting data trends.
• Progressive operational leadership experience.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint.
• 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 to region-based facilities and homes for face-to-face assessments and interactions with members and/or families.
• 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. Individual 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.

Preferred Qualifications

• BSN or an advanced degree in nursing or business-related field.
• Certified Case Manager (CCM).
• Previous experience working in a managed care field.
• 5 or more years of previous management/supervisor level experience.
• Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance. See the "Additional Information" section on language proficiency assessments.

Additional Information

• Workstyle: This is a Remote position that requires some travel.
• Travel: Up to 25% of the time to Humana Healthy Horizons office in Glen Allen, VA for collaboration and face to face meetings as well as field interactions with providers, members, and their families. Note: Travel may exceed 25% in the initial stages of market implementation.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Direct Reports: Up to 15.
• Language Proficiency Assessment: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Work at Home 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 recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• 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

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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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.