Manager, Care Management

About the role

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. This role follows guidelines and departmental procedures, applies advanced technical knowledge to solve moderately complex problems, and receives assignments in the form of objectives to determine approach, resources, schedules, and goals.

Upon hire, this role will be assigned to support either Maternity, Pediatrics, Physical Health, or Behavioral Health. The Manager oversees the assessment and evaluation of members' needs to achieve and maintain optimal wellness by guiding members and families toward appropriate resources. Decisions typically relate to resources, approach, and tactical operations for projects and initiatives within 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.
• Lead 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, 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.

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.

Preferred Qualifications

• 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.

Schedule

• This is a remote position that requires travel.
• Travel: Up to 50% field-based interactions conducting care team oversight visits, meeting with members and/or their families, community partners, and other care teams. May need to attend occasional onsite meetings in Humana's Illinois locations.
• Mileage reimbursement is provided for work-related travel.
• Typical workdays and hours: Monday - Friday, 8:00 AM - 5:00 PM CST. Flexibility may be required based on business needs.
• Direct reports: Up to 15 associates.

Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment. This role is considered patient-facing and is part of Humana’s Tuberculosis (TB) screening program. If selected, you will be required to be screened for TB. This role is also part of Humana's driver safety program, requiring a valid state driver's license and personal vehicle liability insurance with minimum coverage limits or higher.

Work at Home Requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps is required; a wired cable or DSL connection is suggested.

Pay

The pay range for this full-time (40 hours per week) position is $86,300 - $118,700 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive benefits that support whole-person well-being, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off (including paid holidays, parental, and caregiver leave).
• Short-term and long-term disability.
• Life insurance.