Manager, Care Management

Lead a multidisciplinary team of nurses, social workers, behavioral-health professionals, and care coordinators responsible for the care management of Medicaid members in Humana’s Illinois market. Assignments are received as objectives; you determine approach, resources, schedules, and goals.

Responsibilities

• Oversee assessment and evaluation of members’ needs to achieve and maintain optimal wellness by guiding members and families toward appropriate resources.
• 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.
• Align departmental processes and performance with market and enterprise objectives to control cost and improve operational efficiencies.
• Collaborate with internal teams and external partners to ensure seamless integration of non-clinical support associates into care planning and service delivery.
• 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 and advance health equity and reduce 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 adherence to 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 reduce 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

• Monday – Friday, 8:00 AM – 5:00 PM CST; occasional schedule flexibility required based on business needs.
• Up to 50 % field-based travel for care-team oversight visits, member/family meetings, and community-partner engagements; occasional onsite meetings at Humana’s Illinois locations.
• Mileage reimbursement provided for all work-related travel.
• Direct reports: up to 15 associates.

Pay

$86,300 – $118,700 per year. This role is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

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

Work Environment

• Remote position with a dedicated workspace free from ongoing interruptions to protect member PHI/HIPAA information.
• Self-provided internet service must meet minimum download speed of 25 Mbps and upload speed of 10 Mbps (wireless, wired cable, or DSL connection suggested).
• Valid state driver’s license and personal vehicle liability insurance required (minimum $25,000 bodily injury per person/$25,000 bodily injury per event/$10,000 for property damage, or state minimum, whichever is higher).
• Language proficiency assessment (ILR test) required for any associate who speaks with a member in a language other than English.
• Tuberculosis (TB) screening required; this role is considered patient-facing.