Are you ready to make a meaningful impact on the lives of Medicaid members in Illinois? As Manager, Care Management at Humana, you will lead a dynamic, multidisciplinary team of nurses, social workers, behavioral health experts, and care management professionals dedicated to delivering exceptional, integrated care through our Gold Plus-Integrated plan. In this pivotal leadership role, you’ll harness your advanced technical expertise and strategic vision to solve complex challenges, drive innovative approaches to member wellness, and set the course for operational excellence. Join us and play a key part in shaping the future of health equity, collaboration, and community-centered care at Humana.
The Manager, Care Management oversees 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 linesCollaborate 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 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.Use your skills to make an impact
Required Qualifications
5+ years of experience in health care or social services working directly with clients/patients.2+ years of experience providing leadership in a professional setting, such as managing teams, coordinating projects or initiatives, or serving as a subject matter expert.Active Registered Nurse (RN) license or bachelor’s degree in social work or social service-related field.Experience working with Medicare and Medicaid recipients.Knowledge of Medicaid/Medicare, and long-term care guidelines, benefits and policies and procedures.Demonstrated ability to lead cross-functional initiatives and collaborate with external partners.Preferred Qualifications
Master’s degree in nursing, social work, social service-related field and/or licensure in social work.Previous experience working in a managed care field.Previous management/people leader experience.Experience managing or collaborating with community health workers, peer support specialists, or housing programs.Familiarity with Illinois Medicaid policies and systems.Illinois resident.Additional Information
Workstyle: remote, work from home.Work Location: Illinois preferred.Typical Work days/hours: Monday – Friday, 8:00am – 5:00pm CST, occasional flexibility in scheduling may be required to accommodate member and/or department needs.Travel: potential travel for in-person meetings in Illinois.Direct Reports: approximately 10-15.WAH Internet
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.Satellite, cellular and microwave connection can be used only if approved by leadership.Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.