Become a part of our caring community and help us put health first Join Humana as a Case Manager and make a real difference within the Inclusa/Humana team, serving members in the Wisconsin Family Care (FC) program. In this dynamic role, you will collaborate closely with dedicated colleagues to deliver exceptional care and empower our members to thrive in their daily lives. As a Case Manager, you will provide comprehensive social service care management to frail elders and adults with intellectual, developmental, or physical disabilities who qualify for Wisconsin's FC program. Bring your compassion and expertise to help members access vital resources, promote independence, and enhance their quality of life within their communities. We have 1 opening for this role Baldwin/Hudson/River Falls area. Key responsibilities: - Assess members to identify their strengths, interests, and preferences, focusing on health and safety needs to develop a comprehensive Member Care Plan (MCP). - Coordinate services that address members' health and safety needs, ensuring support is provided in the least restrictive environment in accordance with the MCP. - Collaborate continuously with a Field Care Nurse (RN) to review and update care plans and address members' evolving needs. - Conduct face-to-face social assessments with members upon enrollment and at minimum, every six months, typically at the member's residence. - Schedule, conduct, and document quarterly in-person visits and maintain monthly contact with members by phone. - Identify, arrange, and monitor support services for members, including those related to social integration, community resources, employment, housing, and other non-medical needs. - Engage in clear and empathetic communication with members to better understand their needs, support informed decision-making, and ensure cost-effective service delivery. - Prioritize safety by continuously evaluating risk factors and providing education to members to promote overall health and wellness. - Maintain accurate and timely documentation of activities, including case notes, service authorizations, and updates to the Member Care Plan. - Foster direct collaboration with service providers, natural supports, and other community partners to enhance member outcomes. - Travel is necessary to conduct member visits and fulfill role responsibilities. Use your skills to make an impact Required Qualifications - Four-year bachelor's degree in human services or related field with one (1) year of experience working with at least one of the Family Care target populations OR a four-year bachelor's degree in any other field with three (3) years' related experience working with at least one of the Family Care target populations. - Demonstrated intermediate computer proficiency, including experience with Microsoft Office applications. - The Family Care target group population is defined as: frail elders and adults with intellectual, developmental, or physical disabilities*** Preferred Qualifications - Case Management experience - Experience with electronic case note documentation and experience with documenting in multiple computer applications/systems - Knowledge of community health and social service agencies and additional community resources Additional Information - Workstyle: This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. - Work Location: St Croix and Pierce Co - Travel: up to 40% throughout assigned coverage area. Mileage reimbursement follows our mileage policy. - Typical Workdays/Hours: Monday – Friday, 8:00 am – 4:30 pm CST WAH 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 required; 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. Driving This role is 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 100/300/100 limits. TB This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. HireVue 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. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. 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. $53,700 - $72,600 per year 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 About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum. About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.

Department: 10921 Enterprise Corporate - Quality Georgia Area Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Monday-Friday 8:00 AM - 4:30 PM. Some remote opportunities. Pay Range $38.20 - $57.30 EDUCATION/EXPERIENCE: Master's degree in Business, Nursing or Health Care Administration or a related field required with three years' experience in a healthcare provider organization. Demonstrated leadership/management experience required. Experience with CMS regulations preferred. LICENSURE, CERTIFICATION, and/or REGISTRATION: Clinical experience preferred. Two years' project management experience preferred. Demonstrates ability to lead and facilitate projects and teams. RN or other clinical licensure preferred, certification in health care quality, patient safety or related regular entity preferred. ESSENTIAL FUNCTIONS: Identifies and researches innovative techniques /services and outlines the necessary steps to implement changes. Responsible for the implementation of operational performance improvement projects for the Program and aligns with the overall vision and values. Ensures collaboration and integration of operations with other departmental and MSK services. Responsible for the ongoing program management across the continuum and locations, measures compliance with recognized standards of care and achieves operational efficiency, patient satisfaction, quality outcomes, and operational performance goals. Identifying and implementing patient care processes and protocols to promote appropriate utilization of resources. Participates in identifying needs, planning, developing and implementing educational programs for staff, patients, families and/or community groups to improve the care of patients. Promotes and develops personal and professional growth, maintaining professional and clinical knowledge; attends continuing education and in-services as needed. Maintains professional and clinical knowledge, acting as a resource to others. Serves as a clinical expert and resource assisting with care for the complex and/or highly specialized patient care situations, seeking processes to reduce length of stay, cost per patient day, and other patient care efficiencies. Assists institutional financial and operational leaders to develop and implement key projects associated with the service to include, but not limited to: Financial Bundles, Quality Bundles and Patient Satisfaction. Evaluation of new products, improving processes, promoting quality and safety and patient satisfaction. Collects, analyzes, and reports quality data to the orthopaedic department, health system committees, task forces as well as accreditation programs. Pursues and maintains pertinent quality certifications by overseeing adherence of quality standards and protocols as well as reporting required metrics. (JCAHO and AJRR) SKILLS/QUALIFICATIONS: Strong oral and written communication skills with ability to adapt to different audiences. Experience and/or training in process management and process/performance improvement methodologies. Demonstrates use of evidence-based practice to effect quality improvement. Strong time management and multi-tasking skills with ability to prioritize tasks/goals in a timely manner. Effective, strong presentation skills. Strong problem solving, team building and facilitation skills. Knowledge and skill in using computer and network systems with strong background in Microsoft Office programs. Strong analytical and quantitative skills. Solid business writing skill. WORK ENVIRONMENT: Possible exposure to infections and contagious diseases Occasionally subject to irregular hours Subject to many interruptions Occasional pressure due to multiple calls and inquires. Potential remote role with some in person meetings requested. #INDEED456 Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation - Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training - Premium pay such as shift, on call, and more based on a teammate's job - Incentive pay for select positions - Opportunity for annual increases based on performance Benefits and more - Paid Time Off programs - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability - Flexible Spending Accounts for eligible health care and dependent care expenses - Family benefits such as adoption assistance and paid parental leave - Defined contribution retirement plans with employer match and other financial wellness programs - Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Support the development and maintenance of quality improvement related projects specific to HEDIS Hybrid Operations. The position exists to support the health plans in the clinical aspect of medical record review. - Train providers, health plans and staff in methodologies and tools of continuous quality improvement and HEDIS abstraction and over-read processes - Provide clinical support to the medical record abstraction, over-read and audit processes - Monitor performance on established contractual quality indicators. - Analyze, track and trend results - Prepare for and participate in meetings with various committees, state agencies, providers, health plans, vendors, and stakeholders - Recommend, develop, and implement quality performance improvement plans (PIPs) with management utilizing the PDSA model. - Monitor and report PIPs progress through closure. - Performs other duties as assigned - Complies with all policies and standards We are seeking a Quality Improvement Specialist (HEDIS) to join our team! The ideal candidate will bring expertise in: - Must Reside in FL - Quality Improvement - HEDIS Medical Record Abstraction and Overreads - HEDIS Measure Knowledge - NCQA - Computer Savvy - Excellent Customer Service and Communication Skills Education/Experience: Bachelor’s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience. License/Certification: Valid state clinical license preferred (i.e.- LPN, RN, etc.) Experience: Experience in HEDIS or NCQA or related topics preferred Pay Range: $56,200.00 - $101,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

**The hours for this position will likely be 2nd shift and include rotating weekends** **Must be filled in one of the following states: NY MO OH PA AZ FL Job Description POSITION SUMMARY GENERAL RESPONSIBILITIES: - Provide comprehensive drug therapy counseling for patients on medication usage, life-style modifications and preventative care. - Assist patients and members in maximizing plan benefits and personalizing prescription choices to ensure better clinical outcomes - Answer technical questions from patient care advocates, including assisting representatives with member inquiries requiring a pharmacist’s intervention. - Transfer prescriptions to and from retail pharmacies. - Maintain a thorough knowledge of changes in pharmacy practices, laws and drugs and apply knowledge in the performance of daily activities. - Accept, review, and interpret new verbal prescriptions from physician’s offices. - Ensure audit, compliance and legislative requirements are adhered to and appropriate systems and controls are implemented as needed. - Perform other special projects, related duties and responsibilities as assigned. - Back up other pharmacists as needed, perform additional duties as assigned by management, or train less experienced pharmacists. QUALIFICATIONS: - Registered pharmacist in the state of practice - Bachelor’s Degree in Pharmacy or Doctor of Pharmacy from an accredited college of pharmacy. (PharmD preferred) - Must be currently licensed with State Board of Pharmacy and in good standing. - Highly evolved clinical pharmacy skills and/or clinical knowledge of a specific disease state - Demonstrated commitment to ongoing self-study to enhance specialty knowledge - Ability to successfully complete Express Scripts’ required specialist training program - Proficient in windows-based programs. - Must be able to use the keyboard and mouse with reasonable effectiveness. - Must be able to type 30-35 words per minute. - Excellent verbal, written, and listening/communication skills - Demonstrate strong telephone communication skills - Excellent customer service and interpersonal skills - Strong analytical, decision-making, problem-solving abilities and make informed decisions in a timely fashion. - Strong quality orientation; attention to detail; ability to learn and adhere to compliance/ audit requirements. - Strong organization and follow up skills; ability to effectively multi-task and maintain composure in a high-volume environment. - Ability to work independently as well as part of a team. - Solid business acumen and process orientation. - Ability to maintain confidentiality and appropriately handle sensitive information with tact and discretion. - Demonstrated ability to effectively and professionally represent Express Scripts to patients, clinicians, clients and the public. - Must be flexible to work shifts based on business need. - Spanish language fluency is a plus If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 54 - 91 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.