Manager, Care Management (RN or SW) LTSS/HCBS

Humana • Chittenden, VT

3d • $86,300 - $118,700 • Remote

About The Position

The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The LTSS Manager, Care Management oversees Home and Community-Based Services (HCBS) and Long-Term Services and Supports (LTSS) care management operations for Michigan Medicaid members. Responsible for compliance with state contractual requirements, person-centered planning, LTSS assessments, NFLOCD activities, and care coordination supporting members in the least restrictive setting. Provides leadership to Field Care Managers, Nurse Team Leads, Community Health Workers, and support staff.

Requirements

• Active Michigan RN or Social Work license.
• Must reside in Michigan.
• 2+ years of experience in care management, LTSS, and HCBS.
• 2+ years of leadership experience managing clinical or field-based teams.
• Strong knowledge of Medicaid regulations, and person-centered planning.
• Knowledge of Nursing Facility Level of Care Determination (NFLOCD) requirements, InterRAI assessments, and LTSS eligibility processes.
• Experience interpreting regulatory and contractual requirements in managed care environments.
• Experience using performance metrics and operational reporting.

Nice To Haves

• Masters degree in Nursing, Social Work, Public Health, Healthcare Administration, or related field.
• Certified Case Manager (CCM).
• Experience leading Medicaid LTSS, HCBS, or managed care operations.
• Experience supporting dual-eligible, waiver, or HIDE SNP populations.
• Bilingual Spanish, Arabic, or Chaldean Neo-Aramaic

Responsibilities

• Provide leadership and oversight of Michigan LTSS and HCBS care management operations.
• Ensure compliance with Medicaid contracts, CMS requirements, and Humana policies.
• Monitor quality and timeliness of LTSS assessments, reassessments, and care plans.
• Ensure compliance with NFLOCD requirements and regulatory timeframes.
• Oversee InterRAI IHC assessment processes, documentation standards, audits, and staff competency development.
• Use operational and clinical data to identify trends and quality improvement opportunities.
• Support staff managing complex member needs, behavioral health concerns, and social determinants of health.
• Collaborate with Quality, Compliance, Provider Relations, Network, Medical Directors, and State partners.
• Lead audit preparation, readiness reviews, and state monitoring activities.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

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