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Hours Full-time, Part-time
Location miramar, Florida

About this job

Role: RN - Medicaid Pediatric Case Mgt Frontline Leader

Assignment: Medicaid

Location: South Florida (Work at Home and travel to Miramar, FL office)

Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule

Be part of a clinical leadership team, where we provide innovative health solutions to members and providers.

Humana is seeking a Case Mgt Front Line Leader who will hire, lead, and develop clinical and non- clinical professional associates. The Front Line Leader will collaborate with other health care givers in reviewing actual and proposed medical care and services against established Guidelines. As a Clinical Innovations Front Line Leader you will:

Report trends

Develop system-view recommendations

Implement appropriate actions to control trend

Create and conducts provider outreach initiatives

Ensure compliance with regulatory requirements

Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally

Recommend alternatives if appropriate using your knowledge of clinical protocols

Identify members for specific case management and / or disease management activities

Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions

Market level development, implementation and oversight of Case/Disease Management staff.

Telephonic management and coordination of care of patients enrolled in Humana's Medicaid Case/Disease Management Programs by utilization of nursing skills to triage, assess, monitor, evaluate, instruct, intervene and document goals and outcomes.

Coordination of medical management efforts with other Humana departments including, but not limited to Health Services Onsite Staff, Case Management, Quality Improvement and Provider Relations.

Collaborate with Health Services Manager for data collection, reporting and Quality Improvement initiatives on all clinical programs, including evaluating ongoing effectiveness and improvement opportunities.

Key Competencies

Interpersonal Effectiveness: Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships.

Leads Positively : Leads by example to cultivate a climate of motivation, positive energy and meaning in work. Assesses, selects, recognizes, develops, and empowers diverse talent.

Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same. Role Essentials

Current RN license in the state of Florida with no restrictions

Progressive clinical experience preferably in an Pediatric acute care, skilled or rehabilitation clinical setting

Prior supervisory experience

Ability to work independently under general instructions and with a team

Valid drivers license and/or dependable transportation necessary Role Desirables

BSN or Bachelors degree in a related field

Health Plan experience

Prior Medicare / Medicaid experience

Call center or triage experience

May substitute equivalent education and/or experience for degree

Previous Case Management Experience

Bilingual is a plus Reporting Relationships

You will have 10-15 direct reports, and you will report to a director. This area is under the leadership of the SVP & Chief Operating Officer.

Additional Information

At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.

After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what’s happening around our organization in the changing world of healthcare.