Manager, Care Management (RN or SW) Macomb & Wayne Counties

About the Role

The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. This role works within specific guidelines and procedures, applying advanced technical knowledge to solve moderately complex problems. The manager receives assignments in the form of objectives and determines the approach, resources, schedules, and goals. They oversee the assessment and evaluation of members' needs, guiding them toward resources for optimal wellness. This position requires cross-departmental collaboration, conducting briefings, and maintaining frequent contact with other managers across the department.

Responsibilities

• Oversee delivery of care to all members served by the location.
• Review available information related to the member’s case to determine assessment needs.
• Monitor staff performance, including service performance and adherence to care coordination benchmarks.
• Identify members for specific case management and/or disease management activities.
• Develop audit plans and tools to ensure compliance with state contracts and member needs.
• Develop reporting tools in collaboration with leadership to identify clinical performance.
• Responsible for interviewing, hiring, coaching, evaluating, and mentoring a diverse care coordination workforce.
• Onboard new staff, including pre-employment tasks and ordering necessary software, hardware, and supplies.
• Monitor case management activities, post-discharge calls, discharge planning, and pre-assessment of elective admissions.

Requirements

• Must reside in Michigan and be able to travel to Wayne County or Macomb County.
• Active Registered Nurse (RN) license or Social Work (SW) license in the state of Michigan.
• 3+ years of professional experience as a licensed RN or Social Worker, including case and/or disease management.
• 1+ year of leadership and people management experience in a home care, hospice, or similar field-based healthcare setting.
• Demonstrated experience coaching, supporting, and developing clinicians in a fast-paced healthcare environment.
• Proficiency in analyzing and interpreting data trends.
• Comprehensive knowledge of Microsoft Office applications (Word, Excel, PowerPoint).

Qualifications

• Minimum education of an Associate's Degree.
• Certified Case Manager (CCM) preferred.
• 3+ years of previous management/supervisor level experience preferred.
• Experience with Medicaid Long Term Care preferred.
• Fully Bilingual in English and Spanish or Arabic preferred.

Work Details

• Work Location: Michigan (Wayne and Macomb counties)
• Work Style: Remote-field position with travel as needed to support Field Clinicians.
• Schedule/Time Zone: Core hours are Monday – Friday, 8:00am – 5:00pm Eastern Standard Time (EST), with occasional weekend hours as needed.
• Travel Requirements: Up to 50% travel within Wayne and Macomb Counties for field-based interactions.
• Number of Direct Reports: 13

Additional Information

• Language Assessment: Associates speaking with members in a language other than English must take a language proficiency assessment.
• TB Screening: This role is part of Humana’s Tuberculosis (TB) screening program.
• Driving Requirements: Valid state driver's license and personal vehicle liability insurance required. Minimum insurance limits: $25,000 bodily injury per person/$25,000 bodily injury per event/$10,000 for property damage or state minimums, whichever is higher.
• Work at Home Requirements: Minimum internet speed of 25 Mbps download and 10 Mbps upload; dedicated workspace to protect member PHI/HIPAA information.

Pay

The compensation range for this role is $86,300 - $118,700 per year. This position is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive benefits, including medical, dental, and vision insurance, a 401(k) retirement savings plan, paid time off, short-term and long-term disability, life insurance, and more.