Nurse, RN – Call Center
MPF Federal, LLC
Manager, Care Management – Maternal-Child Health
Humana
full-time
Posted on:
Origin: • 🇺🇸 United States • Virginia
Visit company websiteSalary
💰 $86,300 - $118,700 per year
Job Level
Mid-LevelSenior
About the role
- Lead teams of nurses and health professionals responsible for maternal and child services care management
- Supervise care management personnel and oversee assessment, care planning, and care coordination
- Ensure timely and culturally competent delivery of care and supports in compliance with DMAS contractual requirements and industry best practices
- Develop care management policies and procedures to ensure Commonwealth and federal compliance
- Collaborate with internal departments, providers, and community partners to support high-quality case management services
- Introduce innovative approaches to care coordination and influence corporate leadership in strategic planning
- Oversee processes for comprehensive Member assessments to identify individual needs
- Monitor and maintain staffing levels to meet care and service quality objectives
- Support orientation and training of staff and conduct timely evaluations of direct reports
- Collect and analyze performance reports on care management functions to monitor benchmarks and identify improvement opportunities
- Communicate regularly with Members/families, physicians, and facilities/agencies to assure optimal quality patient care
- Coordinate seamless transitions for Members from inpatient settings to community-based services
- Provide ongoing coaching and feedback to enhance contribution, competency, and performance
- Manage up to 15 direct reports and travel to Humana Healthy Horizons office in Glen Allen, VA as needed
Requirements
- 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 management/supervisory experience
- 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 Microsoft Office applications, including Word, Excel and PowerPoint
- Valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits
- Willingness/ability to travel up to 25% (may exceed during initial implementation)
- Ability to work Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST)
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
- TB screening required (patient facing role)
- Language proficiency assessment (ILR) required for associates who speak with members in a language other than English
- Preferred: BSN or an advanced degree in nursing or business-related field
- Preferred: Certified Case Manager (CCM)
- Preferred: Previous MCO management/leadership experience and prior managed care experience
- Preferred: 5 or more years of previous management/supervisor level experience
- Preferred: Bilingual or Multilingual (English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other) - must be able to speak, read and write in both languages without limitations
