Manager, Care Management

Humana • Work at Home - Illinois, IN

7d • $86,300 - $118,700 • Remote

About The Position

The Manager, Care Management leads teams of nurses, social workers, behavioral health professionals, and care coordinators responsible for the care management of Medicaid members in Humana's Illinois market. The Manager, Care Management follows guidelines and departmental procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. Upon hire, this role will be assigned to support either Maternity, Pediatrics, Physical Health, or Behavioral Health. The Manager, Care Management oversees the assessment and evaluation of members' needs and requirements to achieve and maintain optimal wellness by guiding members and families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving the Care Management department. Support and enhance a care management model that leverages extenders (e.g., Community Health Workers, peer support specialists, housing advocates) to address social determinants of health for Medicare-eligible adults. Promote culturally responsive, trauma-informed, and person-centered approaches across all care management activities. Foster partnerships and collaboration between Care Management and community-based organizations, aging services, housing providers, and public agencies. Monitor program performance and use data to evaluate impact, identify gaps, and drive continuous improvement. Leads a multidisciplinary team of Care Managers, Social Workers, and member support associates. Align departmental processes and performance with market and enterprise objectives to control cost and improve operational efficiencies for existing product lines. Collaborate with internal teams and external partners to ensure seamless integration of non-clinical support associates into care planning and service delivery. Assist in coordinating efforts between support departments within the organization. Assure departmental compliance with applicable federal, state, and contractual requirements and standards. Create a productive and positive department through written and verbal communication, briefings and team meetings, and collaboration with other Care Management leadership. Develop and maintain policies and procedures that support consistent, high-quality service delivery across the system of care and contribute to the organization's mission of advancing health equity and reducing disparities. Support training and capacity-building efforts for care management teams. Assist in resolving individual member issues related to housing, food insecurity, transportation, and other social needs. Represent the care management program in collaborative initiatives, advisory groups, and community forums. Participate as a member of the management team in promoting Humana's mission for strategic growth and development. Fully participate in Humana's Compliance Program, including compliance with Humana's Code of Conduct, policies and procedures, and all applicable Privacy and Security laws. Coordinate needed support to operations areas through smooth workflows and cost efficient, quality product delivery. Continuously improve customer satisfaction through effective program monitoring to achieve timely and appropriate service delivery and reduced member problems. Upon hire, this role will be assigned to support either Maternity, Pediatrics, Physical Health, or Behavioral Health.

Requirements

• Must reside in Illinois or a border state
• Bachelor's degree
• Active Registered Nurse (RN) license or Social Work (e.g., LCPC or LCSW) license
• 5+ years of professional experience
• 2+ years of management or supervisory experience.
• Knowledge of IL Medicaid guidelines, benefits and policies and procedures.
• Strong understanding of care management models and the role of extenders in addressing social needs
• Proficiency in analyzing and interpreting data trends.
• Progressive operational leadership experience
• Demonstrated ability to lead cross-functional initiatives and collaborate with external partners
• Ability to operate independently and in a team environment.
• Valid state driver's license
• Personal vehicle liability insurance in accordance with residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
• Minimum download speed of 25 Mbps and an upload speed of 10 Mbps for internet service.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Advanced degree in nursing, health field, or business/healthcare administration
• Previous experience working in a managed care field
• 5 or more years of previous management/supervisor level experience
• Experience managing or collaborating with community health workers, peer support specialists, or housing programs

Responsibilities

• Leads teams of nurses, social workers, behavioral health professionals, and care coordinators responsible for the care management of Medicaid members.
• Oversees the assessment and evaluation of members' needs and requirements to achieve and maintain optimal wellness by guiding members and families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.
• Supports and enhances a care management model that leverages extenders to address social determinants of health.
• Promotes culturally responsive, trauma-informed, and person-centered approaches across all care management activities.
• Fosters partnerships and collaboration between Care Management and community-based organizations, aging services, housing providers, and public agencies.
• Monitors program performance and uses data to evaluate impact, identify gaps, and drive continuous improvement.
• Leads a multidisciplinary team of Care Managers, Social Workers, and member support associates.
• Aligns departmental processes and performance with market and enterprise objectives to control cost and improve operational efficiencies.
• Collaborates with internal teams and external partners to ensure seamless integration of non-clinical support associates into care planning and service delivery.
• Assures departmental compliance with applicable federal, state, and contractual requirements and standards.
• Creates a productive and positive department through communication, briefings, team meetings, and collaboration with other Care Management leadership.
• Develops and maintains policies and procedures that support consistent, high-quality service delivery and contribute to the organization's mission of advancing health equity and reducing disparities.
• Supports training and capacity-building efforts for care management teams.
• Assists in resolving individual member issues related to housing, food insecurity, transportation, and other social needs.
• Represents the care management program in collaborative initiatives, advisory groups, and community forums.
• Participates as a member of the management team in promoting Humana's mission for strategic growth and development.
• Fully participates in Humana's Compliance Program.
• Coordinates needed support to operations areas through smooth workflows and cost efficient, quality product delivery.
• Continuously improves customer satisfaction through effective program monitoring to achieve timely and appropriate service delivery and reduced member problems.

Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term disability
• Long-term disability
• Life insurance
• Mileage reimbursement for travel

What This Job Offers

• Job Type: Full-time
• Career Level: Manager