Humana Associate Director, Care Management - Louisiana Medicaid in Baton Rouge, Louisiana
The Associate Director, Care Management leads teams of nurses and behavior health professionals responsible for care management. This role requires a solid understanding of how organization capabilities interrelate across department(s)
The Associate Director, 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 identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates. This role will lead case management operations and staff to ensure timely and culturally-competent delivery of care, services, and supports in compliance with Louisiana Department of Health (LDH) contractual requirements and industry best practices.
Essential Functions and Responsibilities
Supervise case management personnel and oversee all case management functions, including assessment, care planning, and care coordination
Lead development of case management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices
Collaborate with internal departments, providers, and community partners to support the delivery of high-quality case management services, including introducing innovative approaches to care coordination
Utilize a holistic, enrollee-centric approach to engage and motivate enrollees and their families through recovery and health and wellness programs
Oversee the processes for comprehensive enrollee assessments to identify their individual needs
Perform clinical intervention through the development of a care plan specific to each enrollee based on clinical judgement, changes in enrollees’ health or psychosocial wellness, and identified triggers
Communicate regularly with enrollees/families, physicians, and facilities/agencies to assure optimal quality patient care and effective operations
Collaborate with relevant internal and external partners to coordinate seamless transitions for enrollees from inpatient settings to community-based services
Monitor and maintain staffing levels to meet care and service quality objectives
Manage orientation and training of supervisees
Conduct timely evaluations of direct reports and provide regular opportunities for professional development
Influence and assist corporate leadership in strategic planning to improve effectiveness of case and disease management programs
Collect and analyze performance reports on case management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership
You will have 1-8 direct reports
Travel LA Market Office as determined by the needs of the business (Agile Work Environment)
Required Education, Certification, & Experience Qualifications
Minimum five (5) years of management/supervisory experience in healthcare
Licensed registered nurse, licensed mental health practitioner, or similar training/certification
Case Management experience
More than one (1) year of leadership experience
Preferred Experience Qualifications
Certified Case Manager
Fluency in French, Spanish or Vietnamese
Experience serving Medicaid, TANF, and/or CHIP populations
Master’s degree in social work, nursing, health administration, or related field
As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, 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 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.
Scheduled Weekly Hours
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
Equal Opportunity Employer
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