Manager, Care Management

Become a part of our caring community. 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

• Oversee 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.
• Support and enhance a care management model that leverages extenders (e.g., CHWs, 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 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 effort 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 extenders, including CHWs and peer specialists.
• 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 MLTSS or LTSS based on business needs.

Requirements

• Must reside 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.
• Demonstrated computer skills in Microsoft Windows, Outlook, Excel, Word as well as other MIS software applications.
• 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.

Schedule

• Typical workdays: Monday - Friday, 8:00 AM - 5:00 PM CST.
• May need to provide flexibility with work schedule based on business needs.
• Direct reports: Up to 15 associates.

Workstyle

• This is a remote position that requires travel.
• Travel: 50 – 75% 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.

Pay

The pay range for this role is $86,300 - $118,700 per year. This job 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 paid holidays, company and personal holidays, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.
• Employees who live and work from home in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide telephone equipment appropriate to meet business requirements.

Additional Information

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• This role requires a valid state driver's license and maintenance of personal vehicle liability insurance (minimum $25,000 bodily injury per person/$25,000 bodily injury per event/$10,000 for property damage or state minimum required limits, whichever is higher).
• This role is considered patient-facing and requires tuberculosis (TB) screening.
• Internet requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable, or DSL connection suggested.
• Language proficiency assessment required for associates speaking with members in a language other than English.

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health.