Manager, Care Management

About the Role

Employment Type: Full time

Become a part of our caring community and help us put health first. 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.

Responsibilities

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 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 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.