Care Management Support Lead

Humana • Chittenden, VT

4d • Remote

About The Position

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

Requirements

• 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.

Nice To Haves

• 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.

Responsibilities

• 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).
• 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.
• 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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees