Manager Care Management

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Job Information
Humana
Manager, Care Management
in
Cincinnati
Ohio
Description
Responsibilities
The Care Management Manager has responsibilities for the administration, clinical and operational management and compliance with Defense Health Agency policy, URAC Accreditation and federal legislation. The Manager will lead a team of multidisciplinary clinicians and specialists in delivery of care to a specific beneficiary population in accordance with the Autism Care Demonstration (ACD), as it specifically relates to Utilization Management (UM), Case management (CM), Care Coordination (CC) and Quality Management (QM) for TRICARE East; maintaining contractual standards, improving clinical and financial outcomes, and exceeding beneficiary expectations. The Manager will provide clinical guidance, operational oversight and support to the ACD team influencing HGB's ability to achieve the strategic priorities related to T2017 Contract. The Manager will be responsible for workload management, monitoring of caseloads and distribution; provide coverage for all holidays, both standard and non-standard, as well as support contingency operations. Additionally, must be able to manage multiple direct reports and business relationships for projects, which require flexibility, and adaptability for evolving government regulations.
KEY ACCOUNTABILITIES
Manage all aspects of day-to-day operations of the ACD Team to ensure identified contractual requirements are met. This includes oversight of all ACD authorization activities to include, medical necessity review, case management, care coordination, ABA queue call management and performance standards; Establish and maintain open communication and collaborative relationships with other managers, HGB associates, providers, MTFs, eMSMs, to resolve beneficiary or provider complaints and grievances and/or DHA concerns as necessary; Coordinates and implements contingency operations when needed.
Implement operational metrics to ensure attainment of the programs' goals and performance standards.
Collaborate with all Humana operations departments to operate and improve processes related to ACD team performance and monitor the effectiveness with the highest degree of attention to beneficiary and provider experience; Support the strategies for efficiency and system improvement, including monitoring the implementation of process changes; Provides area oversight and interfaces with quality management and medical management programs ensuring beneficiary coordination of care.
Assist in the collection, analyzation and updates on a variety of referral, authorization, provider steerage and utilization management data; Analyze operational reports to reduce errors, increase data accuracy, review provider availability, and monitor un-activated referrals; Evaluates and applies performance and outcome results to improve organizational policies and procedures, to maximize workflow and efficiency, and to create best value for our beneficiaries and Government partners .
Maintain training documents, job aides and assist in ensuring documents are updated as needed for process changes.
Leads by example and complies with Humana Government Business Values and Talent Leadership expectations, including hiring, supervising, and training assigned associates
Required Qualifications
Our Department of Defense Contract requires U.S. citizenship for this position
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
A current, valid, and unrestricted license to include: Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional license.
Knowledge of and experience with applied behavior analysis and integrated care needs for those with autism
Minimum of five (5) years of managed care, UM, CM, QM or DM experience
Minimum of three (3) years of clinical supervisory experience and personnel management
Must have an active designation as a Certified Case Manager (CCM)
Ability to handle multiple projects simultaneously and to prioritize appropriately
Experience with Microsoft Office products for business presentations
Skilled written and verbal communications
We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to provide proof of full vaccination where allowed by law. Medical and religious exemptions will be considered on a case-by-case basis
Preferred Qualifications
Prior experience with the TRICARE Autism Care Demonstration
Experience in budget planning, tracking performance against daily and weekly metrics, and operational experience
Extensive analytical skills
Scheduled Weekly Hours
40

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