RN Manager Care Management - Mid Atlantic Region

Profile

Description

The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management 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.

Responsibilities

We value people and if you succeed, we succeed! The Manager, Care Management oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.


Develop, Implement and maintain all activities and processes necessary to maintain compliance with NCQA and MMOC standards and regulatory requirements.
Work collaboratively with leadership to achieve and maintain compliance.
Collect and analyze data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals.
Provide open communication and perfect service to other departments, vendors, and providers throughout the region.
Weekly review of SCM nurses queues for compliance/ management of assignments.
Identify education needs of team. Work with QA Process Education team to meet identified opportunities to support the management and leadership of the department daily.


What Humana Offers

We are fortunate to offer a remote - work at home opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications - What it takes to Succeed


Associate's degree
5 or more years of professional experience
Active Registered Nurse (RN) license
3 or more years of case management experience
Proficiency in analyzing and interpreting data trends.
Progressive business consulting and/or operational leadership experience
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work
Must provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Bachelor's degree or advanced degree in nursing or business health field
Previous experience working in a managed care field
5 or more years of previous management/supervisor level experience


Additional Information - How we Value You


Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being


Scheduled Weekly Hours

40

Company info

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