Manager, Care Management (maternal - child Health) - Remote Eligible

Manager, Care Management (Maternal-Child Health)

Humana Healthy Horizons in Virginia is seeking a Manager, Care Management (Maternal-Child Health) who will lead teams of nurses and health professionals responsible for maternal and child services care management. The Manager 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. The Maternal and Child Services Manager ensures timely and culturally competent delivery of care, services, and supports in compliance with the Virginia Department of Medical Assistance Services (DMAS) contractual requirements and industry best practices.

Responsibilities include:

• Supervising care management personnel and overseeing all care management functions, including assessment, care planning, and care coordination.
• Leading development of care management policies and procedures to ensure compliance with Commonwealth and federal requirements and incorporate industry best practices.
• Collaborating with internal departments, providers, and community partners to support the delivery of high-quality case management services, including introducing innovative approaches to care coordination.
• Overseeing the processes for comprehensive member assessments to identify their individual needs.
• Monitoring and maintaining staffing levels to meet care and service quality objectives.
• Supporting orientation and training of staff.
• Conducting timely evaluations of direct reports and providing regular opportunities for professional development.
• Influencing and assisting corporate leadership in strategic planning to improve the effectiveness of care and disease management programs for Maternal-Child health.
• Participating in Care Management collaborative meetings as required by the Department of Medical Assistance (DMAS).
• Collecting and analyzing performance reports on care management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
• Ability to work independently under general instructions and with a team.
• Utilizing a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs.
• Performing clinical intervention through the development of a care plan specific to each member based on clinical judgment, changes in members' health or psychosocial wellness, and identified triggers.
• Communicating regularly with members/families, physicians, and facilities/agencies to assure optimal quality patient care and effective operations.
• Collaborating with relevant internal and external partners to coordinate seamless transitions for members from inpatient settings to community-based services.
• Providing ongoing coaching and feedback to enhance contribution, competency, and performance.

Required Qualifications:

• Must reside in the Commonwealth of Virginia.
• Active RN license in the Commonwealth of Virginia, with no disciplinary action.
• Minimum three (3) years of experience working in the Maternal-Child health field.
• Minimum two (2) years of MCO management/supervisory experience.
• Understanding of the Cardinal Care Contract.
• Experience serving Medicaid, Medicaid/Medicare, TANF, and/or CHIP populations.
• Previous experience in managing/leading a team.
• Experience in case management.
• Proficiency in analyzing and interpreting data trends.
• Progressive operational leadership experience.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.

Preferred Qualifications:

• BSN or an advanced degree in nursing or business-related field.
• Certified Case Manager (CCM).
• Previous MCO management/leadership experience.
• Previous direct experience working in a managed care field.
• 5 or more years of previous management/supervisor level experience.
• Bilingual or multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance.

This is a remote position that requires some travel. Up to 25% of the time to Humana Healthy Horizons office in Glen Allen, VA for collaboration and face to face meetings as well as field interactions with providers, members, and their families. Typical workdays and hours are Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST). Direct reports: up to 15.

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. These include 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, parental and caregiver leave, employee charity matching program, network resource groups, and career development opportunities.

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Scheduled weekly hours: 40. Pay range: $86,300 - $118,700 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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.

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.

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.