Associate Director, Care Management
Posted on: January 21, 2023
DescriptionHumana Healthy Horizons in Florida is seeking an
Associate Director, Care Management who will lead teams of nurses
and behavior health professionals responsible for care management.
The Associate Director, Care Management requires a solid
understanding of how organization capabilities interrelate across
department(s).ResponsibilitiesThe Associate Director, Care
Management leads and guides others in providing integrated services
to and for our customers.
- Oversees the day to day operations for FL LTSS Program to
- Provides ongoing associate coaching and feedback to enhance
associate contribution, competency, and performance.
- Attracts, develops, empowers and inspires talent to help Humana
Healthy Horizons deliver on their contractual and business
- Leads a team that can deliver LTSS services to our members with
an agile approach in partnership with technology, provider
relations, MMA partners and other key stakeholders while managing
operational risks and contractual/regulatory risks.
- Reimagines and innovates ways to create efficiencies to improve
both the associate and member experience.
- Achieve performance metrics for a fast paced comprehensive case
- Assure contractual compliance with mandated and corporate
policies regarding other departmental areas such as medical
management, utilization management and case 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 well-being of members.
- Decisions are typically related to identifying and resolving
complex technical and operational problems within
- Requires cross departmental collaboration, and conducts
briefings and area meetings; maintains frequent communications with
- Ensures the delivery of services to our members to create a
seamless and easy experiences.
- Leads assigned initiatives and projects to support the program
and our path forward.Required Qualification
- Must reside in the Florida.
- Licensed Registered Nurse (RN) or Licensed Clinical Social
Worker (LCSW) in the state of Florida without restrictions.
- 5 or more years of managed care experience in Medicare and/or
- 3 - 5 or more years of management/leadership experience.
- Comprehensive knowledge of all Microsoft Office applications,
including Word, Excel, and PowerPoint.
- Proficiency in analyzing and interpreting data trends.
- Knowledge of Medicaid Florida regulatory requirements.
- Demonstrated progressive experiences with audits and corrective
- Strong understanding of utilization management and utilization
- Demonstrated ability to manage multiple competing priorities
and delegate accordingly.
- Ability to reimagine and innovate ways to create efficiencies
to improve both the associate and member experience.
- Strong problem-solving skills with the ability to shift focus
- Strong critical-thinking skills with the ability to operate and
- Strong business acumen.
- Must be able to travel throughout the state of Florida with
possible overnight stays.
- ACHA Level II Fingerprints required.
- This role is a 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 100,000/300,000/100,000 limits.Work at Home Requirements
- At minimum, a download speed of 25 Mbps and an upload speed of
10 Mbps is recommended; wireless, wired cable or DSL connection is
- Satellite, cellular and microwave connection can be used only
if approved by leadership.
- Associates 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 associates 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.Preferred Qualifications
- Reside in Region 1, 2 or 3, preferred.
- Knowledge of National Committee for Quality Assurance (NCQA)
- Demonstrated progressive experiences with ACHA audits and
corrective action plans.
- Intermediate to advanced proficiency in CGX
- Location: Remote.
- Travel: 25% - In state travel.
- Direct Reports: Up to 6 Managers.
- Vaccination Statement: Humana and its subsidiaries require
vaccinated associates who work outside of their home to submit
proof of vaccination, including COVID-19 boosters. Associates who
remain unvaccinated must either undergo weekly negative COVID
testing OR wear a mask at all times while in a Humana facility or
while working in the field.Interview FormatAs part of our hiring
process, we will be using an exciting interviewing technology
provided by Modern Hire/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.Social Security
TaskAlert: Humana values personal identity protection. Please be
aware that applicants being considered for an interview will be
asked to provide a social security number, if it is not already on
file. When required, an email will be sent from
Humana@myworkday.com with instructions to add the information into
the application at Humana's secure website.Scheduled Weekly
Hours40Humana complies with all applicable federal civil rights
laws and does not discriminate on the basis of race, color,
national origin, age, disability, sex, sexual orientation, gender
identity or religion. We also provide free language interpreter
services. See our
Keywords: Humana, Hialeah , Associate Director, Care Management, Executive , Hialeah, Florida
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