Manager, Care/Case Management

Humana • Glendale, AZ

253d • $86,300 - $118,700 • Onsite

About The Position

The Manager Care/Case Management is responsible for managing a team of nurses, community health workers, and behavioral health resources who engage high risk/high needs patients using a team-based approach to ensure patients receive the individualized care and services they need to reach optimal health. The Manager is also responsible for building strong partnerships with clinical-operational market leaders on Care Integration Team foundational program and strategic opportunities for managing populations and coordinating care to reduce acute and post-acute care utilization. The Manager role is hybrid with travel requirements to preferred healthcare facilities in the community, alongside clinical market leader, to develop clinical partnerships for timely access to patient information, clinical collaboration on patient care, and patient centered resources. As a guideline, this role involves spending 50% of the time on operational excellence and program delivery, 25% on relationships, and 25% on community partnerships.

Requirements

• A current unrestricted state RN license or Social Work degree/license.
• 5 years or more prior nursing, case management, disease management and/or social work experience.
• At least 2 years of team management experience.
• Experience working in primary care, acute care, ambulatory care and/or value-based care organizations.
• Proficiency in analyzing and interpreting data trends.
• Progressive business consulting and operational leadership experience.
• Comprehensive knowledge in Microsoft office products.
• Must be passionate about contributing to an organization focused on continuously improving customer experience.
• Must provide a high-speed DSL or cable modem for home office.
• Must have a separate room with a locked door that can be used as home office to ensure you have absolute privacy.
• Driving required to community organizations, health systems, and CW centers.

Nice To Haves

• Bilingual in English/Spanish with the ability to speak, read and write in both languages without limitations and assistance.

Responsibilities

• Oversees day-to-day operations, quality chart audit reviews, recruiting/hiring, team management, and overall performance for Care Integration Team associates in the market.
• Ensures clinical program integrity at the market level and addresses performance and program improvement opportunities, escalating to Divisional Director as appropriate.
• Collaborates with market leader/key stakeholders to design market specific strategies, data analytics, and create action plans that will reduce acute and post-acute care utilization.
• Solicits feedback with market leaders on team-based focus with attention given to success and opportunities to improve one care team culture and collaboration on high-risk patient management, at the market level.
• Initiates and maintains relationships with community partners, including key community organizations, Centerwell organizations (home health and pharmacy), and health care systems for strong clinical collaboration that will improve patient experience and overall population health outcomes.
• Accountability to key population health metrics, including quality, utilization and financial measures.

Benefits

• Health benefits effective day 1.
• Paid time off, holidays, volunteer time and jury duty pay.
• Recognition pay.
• 401(k) retirement savings plan with employer match.
• Tuition assistance.
• Scholarships for eligible dependents.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree