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

Humana Gold Plus Integrated is seeking a Director of Care Management to lead a team of nurses and behavioral health professionals responsible for Care Management for IL FIDE-SNP members. The Director will use 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 Members.

The Director of Care Management coordinates and communicates with Providers, Members, or other parties to facilitate optimal care and treatment, and decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

The Director of Care Management requires an in-depth understanding of how organization capabilities interrelate across the team, Illinois Medicare and Medicaid markets, and the enterprise. This is a dynamic role requiring strong leadership experience, critical thinking/problem solving skills, and a strategic mindset. This position is dedicated to the Illinois Medicaid plan.

The Director of Care Management responsibilities include:

• Develops, oversees, and nurtures teams (Care Coordination, Care Navigation, Case Management, Transition Coordination, Service Coordination, HRSN and support teams) with appropriate onboarding, training, and advancement opportunities, including fostering diversity and inclusion, local and Illinois FIDE-SNP -specific knowledge, cultural and linguistic competency, superior service delivery, succession planning, and accountability.
• Leads departmental post-award activities such as contract review, compliance, readiness review, and implementation.
• Develops and implements strategies to support Members’ goals for aging at home/in the community, transitions between settings and between MCOs, and continuity of care throughout the members’ health care journey.
• Collaborates with plan leadership on process improvements, trends analysis, and operational efficiencies.
• Reports to plan leadership on departmental performance, challenges, opportunities, risks, and recommendations for improvements/changes.
• Ensures compliance with the contract, CMS and Department of Healthcare and Family Services (HFS) policies, procedures, and regulations.
• Oversees appropriate data sharing between internal and external resources to support whole-person care, continuity of care, and service integration.
• Collaborates with Population Health, Equity, Quality, and Clinical leaders to reduce barriers to care, decrease health disparities, support at-risk, underserved, and rural communities, and address HRSNs that impact Members’ health and well-being.
• Reviews data to identify gaps in care and creates solutions to address these areas.
• Fosters positive relationships with HFS, local and state health agencies, subcontractors, providers, hospitals, nursing and assisted living facilities, member advocacy groups, community organizations, and other stakeholders.
• Manages departmental budget and maintain cost efficiencies.
• Participate in Care Management Collaborative meetings as required by HFS.

Use your skills to make an impact

Required Qualifications

• Must live in or be willing to relocate to the State of Illinois.
• Bachelor's degree.
• Clinical licensure including but not limited to RN, LCSW, LCPC.
• 8+ years of clinical experience, to include a combination of Utilization Management Case Management and Managed Care.
• 5+ years of direct management experience.
• 5+ years of experience working with DSNP and Medicare programs.
• 2+ years of project leadership experience.
• Previous experience with electronic case notes documentation and experience with documenting in multiple computer applications/systems.
• Prior experience leading an integrated care team.
• Experience creating and managing department budgets.
• Experience working with Medicaid and Medicare populations.
• Intermediate to advanced knowledge of Microsoft Suite applications, specifically Word, Excel, and PowerPoint.
• Experience with data analysis, understanding, communicating, and reporting on operational trends and gaps.

Preferred Qualifications

• Master’s degree.
• Case Management Certification (CCM).

Work at Home Requirements

• 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.
• Associates 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 associates 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.

Additional Information

• Direct Reports: Up to 10 associates.
• Workstyle: Remote; must live in the State of Illinois.
• Travel: Up to 5% travel in the state of Illinois.
• Core Workdays & Hours: Typically, 8-5 pm Monday – Friday; Central Standard Time (CST) with flexible scheduling (i.e. occasional nights and weekends).
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

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.

$126,300 - $173,700 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.