Manager, Care Management

About the role

The Manager, Care Management leads teams of nurses, social workers, behavioral health professionals, and care management support professionals responsible for the care management of Medicaid members in Humana's Illinois market.

Responsibilities

• Oversight of assessment and evaluation of members' needs and requirements to achieve and maintain optimal wellness
• Guiding members and families toward and facilitating interaction with resources appropriate for the care and wellbeing of members
• Leveraging extenders (e.g., CHWs, peer support specialists, housing advocates) to address social determinants of health for Medicare-eligible adults
• Promoting culturally responsive, trauma-informed, and person-centered approaches across all care management activities
• Fostering partnerships and collaboration between Care Management and community-based organizations, aging services, housing providers, and public agencies
• Monitoring program performance and using data to evaluate impact, identify gaps, and drive continuous improvement
• Alligning departmental processes and performance with market and enterprise objectives to control cost and improve operational efficiencies for existing product lines
• Collaborating with internal teams and external partners to ensure seamless integration of non-clinical support associates into care planning and service delivery
• Assisting in coordinating effort between support departments within the organization
• Communicating effectively through written and verbal communication, briefings, and team meetings
• Collaborating with other Care Management leadership
• Developing and maintaining policies and procedures that support consistent, high-quality service delivery across the system of care
• Supporting training and capacity-building efforts for care management extenders, including CHWs and peer specialists
• Assisting in resolving individual member issues related to housing, food insecurity, transportation, and other social needs
• Representing the care management program in collaborative initiatives, advisory groups, and community forums
• Participating as a member of the management team in promoting Humana's mission for strategic growth and development
• Complying with Humana's Compliance Program, including Code of Conduct, policies and procedures, and all applicable Privacy and Security laws
• Coordinating needed support to operations areas through smooth workflows and cost-efficient, quality product delivery
• Continuously improving customer satisfaction through effective program monitoring to achieve timely and appropriate service delivery and reduced member problems

Requirements

• Resides in Illinois
• Minimum of an Associate's Degree
• Active Registered Nurse (RN) license or Social Work (SW) license
• 5+ years of professional experience
• 2+ years of management or supervisory experience
• Proficiency in analyzing and interpreting data trends
• Progressive operational leadership experience
• Strong, demonstrated communication, analytical, problem-solving, and team-playing skills
• Knowledge of Medicaid/Medicare, and long-term care guidelines, benefits, and policies and procedures
• Proficiency in analyzing and interpreting data trends
• Strong understanding of care management models and the role of extenders in addressing social needs
• Demonstrated ability to lead cross-functional initiatives and collaborate with external partners
• Ability to operate independently and in a team environment

Preferred Qualifications

• Bachelor's degree or advanced degree in nursing or business health field
• 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
• Familiarity with Illinois Medicaid policies and systems