Hybrid Remote Director, Care Management (LTSS) – RN – Virginia

Job Overview

  • Clinical License RN
  • State(s) VA

About this job

Become a part of our caring community and help us put health first

Humana Healthy Horizons in Virginia is seeking a Director, Care Management of Long-Term Services and Supports (LTSS) who will lead teams of nurses and behavior health professionals responsible for care management. The Director, Care Management (LTSS) requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

 

The Director, Care Management (LTSS) will provide oversight to ensure the company’s Long‐Term Services and Supports (LTSS) Care Management and Contractual performance objectives are met for the Virginia Cardinal Care Medicaid program. They will ensure the program and resources are used effectively and successfully to execute short and long‐term population health goals.

 

  • Leads, develops, and operationalizes LTSS Care Management/Coordination within Humana’s Population Health strategy, education, and Quality Improvement activities for the clinical team.
  • Develops, implements, measures, analyzes, and reports on LTSS programs and initiatives designed to improve the health and quality of life of our members.
  • Ensures best practice standards and the NCQA Care Management criteria are used to assist with developing the documentation tools to create impactful member outcomes.
  • Responsible for the planning, directing, and successful management of the LTSS Clinical Strategy for Department of Medical Assistance Services (DMAS) in Virginia.
  • Provides input into function’s strategy.
  • Leads, mentors, exemplifies, and inspires teams responsible for LTSS Care Management.
  • Contributes to the success of associate and member experience in assigned region as well as across the Commonwealth/enterprise.
  • Oversees the assessment and evaluation of members’ needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitating interaction with resources appropriate for the care and well‐being of members.
  • Makes decisions typically related to the implementation of new/updated programs or large‐ scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance.
  • Develops and maintains functioning teams to accomplish goals set by the division.
  • Encourages professional responsibility and assists with professional development.
  • Defines key personnel productivity and quality indicators that meet industry standards.
  • When necessary, develops and updates process improvement plans for internal and external customers.
  • Develops education and training programs for LTSS Care Management team, inclusive of case review and case study.
  • Collaborates with other Humana leadership to identify the clinical tools and systems to support LTSS Care Management activities.
  • Participates in Care Management Collaborative meetings as required by DMAS.
  • Ensures that the Health Services team operates in compliance with Commonwealth and federal regulations, Commonwealth Contract Requirements, Humana Policies and NCQA Standards.

Use your skills to make an impact

Required Qualifications

  • Must reside in the Commonwealth of Virginia.
  • Bachelor’s degree.
  • An active unrestricted Registered Nurse (RN) license in Virginia.
  • Combination of eight (8) or more years of care management and care coordination experience.
  • Two (2) or more years of experience working in the LTSS industry.
  • Five (5) years of leadership experience leading large teams with proven success in directing and leading these teams.
  • Prior work experience working with elderly, disabled, private duty nursing and/or nursing facility populations.
  • Proven success in team building and training/coaching staff to meet operational requirements and goals.
  • Proficiency in analyzing and interpreting clinical and utilization trends.
  • Thorough understanding of health plan and regulatory rules, managed care, care management, disease management and referral processes.
  • Ability to analyze and integrate information and make sound decisions based upon established guidelines.
  • Commitment to the creation of a collaborative and supportive work environment.

Preferred Qualifications

  • Master’s degree in business administration, Nursing or a related field preferred.
  • Care Management certification (CCM).

Additional Information

  • Workstyle: This is a Remote position that will require you to travel.
  • 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 interfacing with regulatory agencies.
  • Direct Reports: Up to 5.

Work at Home Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  • Satellite, cellular and microwave connection can be used only if approved by leadership.
  • Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

 

Scheduled Weekly Hours

 

40

 

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$123,800 – $170,400 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

 

Description of Benefits

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.

About us

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.

 

Equal Opportunity Employer

 

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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

 

 

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