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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in care management and team leadership, with a strong focus on compliance, performance metrics, and effective communication within healthcare settings. Proficient in data analysis and electronic medical records, ensuring high-quality care coordination and operational efficiency.
Highest-signal resume keywords
Registered Nurse (RN) LicenseLeadership ExperienceCare ManagementData AnalysisCertified Case Manager (CCM)
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care CoordinationPerformance MetricsHealthcare Quality MeasuresElectronic Medical RecordsData Trend AnalysisAudit PlanningDischarge PlanningCase Management ActivitiesStaff Performance MonitoringCommunity Health Knowledge
Soft Skills
Team LeadershipCommunicationMentoringCoachingCollaboration
Tools & Technologies
Electronic Information ApplicationsReporting ToolsHuman Resources Software
Certifications & Qualifications
Licensed Clinical Social Worker (LCSW)Licensed Clinical Professional Counselor (LCPC)Certified Case Manager (CCM)
Industry Keywords
Managed CareHealth Care IndustryCare ManagementCommunity ResourcesHIPAA Compliance
About the role
Key responsibilities & impact- Lead teams of nurses, care coordinators and behavioral health professionals responsible for care management
- Supervise, direct and evaluate health care professionals to ensure effective care coordination
- Lead cross-functional collaboration through briefings and area meetings
- Maintain communication with departmental managers to ensure alignment and operational efficiency
- Identify members for case management and/or disease management activities
- Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions
- Develop system-view recommendations, report trends and implement actions to control trends
- Develop audit plans and tools to ensure compliance with state contracts and performance metrics
- Develop reporting tools with leadership to identify clinical performance
- Interview, hire, mentor, evaluate, coach and manage performance for a diverse care coordination team
- Onboard new associates and coordinate human resources tasks, software, hardware, supplies and support technologies
- Monitor staff performance against service, utilization and care coordination benchmarks
- Conduct field-based care team oversight visits and meetings with members, families, community partners and care teams
- Travel approximately 25% and attend occasional onsite meetings at Humana Illinois locations
- Manage up to 15 direct reports
Requirements
What you’ll need- Applicants must reside in Illinois in Cook County, within the listed ZIP codes or within a 10-mile radius of those ZIP codes
- Active, unrestricted Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or Licensed Clinical Professional Counselor (LCPC) license in Illinois
- Five (5) or more years of professional experience working in the health care industry and/or in care management
- Two (2) or more years of leadership experience
- Ability to use electronic information applications/software programs, including electronic medical records
- Proficiency in analyzing and interpreting data trends
- Ability to travel throughout Illinois
- Advanced degree in nursing or business health field (preferred)
- Certified Case Manager (CCM) (preferred)
- Previous managed care experience (preferred)
- Five (5) or more years of management/supervisor-level experience, including hiring, training, mentoring and coaching associates (preferred)
- Experience with healthcare quality measures such as STARS and HEDIS and/or clinical program monitoring/evaluation (preferred)
- Knowledge of community health and social service agencies and community resources (preferred)
- Bilingual or multilingual ability, including English/Spanish, Arabic, Vietnamese, Amharic, Urdu or another language (preferred); must speak, read and write both languages without limitations and assistance
- Valid state driver's license
- Personal vehicle liability insurance meeting applicable minimum limits
- Minimum home internet speeds of 25 Mbps download and 10 Mbps upload
- Dedicated work space without ongoing interruptions to protect member PHI/HIPAA information
- Willingness to complete TB screening
- Willingness to complete the Interagency Language Rating (ILR) test if applicable
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Remote work arrangement
- Flexible work schedule based on business needs