Manager, Care Management

Position Overview

Become a part of our caring community and help us put health first. The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. This role involves working within specific guidelines and procedures, applying advanced technical knowledge to solve moderately complex problems, and receiving assignments in the form of objectives to determine approach, resources, schedules, and goals.

Employment Type

• Full-time

Location

• Remote
• Requires 50-75% travel in Wayne County or Macomb County, Michigan.
• Must reside in Michigan with the capability to drive to Wayne County or Macomb County.

Responsibilities

• Oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness by guiding members/families toward and facilitating interaction with resources appropriate for the care and wellbeing of members.
• Requires cross-departmental collaboration and conducts briefings and area meetings.
• Maintains frequent contact with other managers across the department.
• Responsible for and oversees the delivery of care to all members served by the location.
• Reviews available information related to the member’s case, including disciplines required, to determine assessment needs.
• Monitors the performance of staff, including service performance and adherence to established care coordination benchmarks.
• Identifies members for specific case management and/or disease management activities.
• Develops audit plans and tools for teams to ensure compliance with state contract on performance metrics and to ensure member needs are met.
• Develops reporting tools in collaboration with leadership to identify clinical performance.
• Responsible for interviewing, hiring, coaching, evaluating, and mentoring a diverse care coordination workforce.
• Onboards new staff, including pre-employment human resource tasks, and ordering of software, hardware, supplies, and support technologies.
• Monitors case management activities, post-discharge calls, discharge planning, and pre-assessment of elective admissions.

Required Qualifications

• 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.
• Minimum education of an Associate's Degree.
• Minimum 5 years of professional experience as a licensed RN or Social Worker, including experience in case and/or disease management.
• Minimum 2 years of management experience, with at least 1 year of management experience in a home care, hospice, or equivalent field-based environment.
• Proven ability in providing support to clinicians' well-being and building resilience when faced with challenges.
• Proficiency in analyzing and interpreting data trends.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
• Must have a separate room with a locked door that can be used as a home office to ensure absolute and continuous privacy while working.
• Valid state driver’s license and proof of vehicle liability insurance (in accordance with state minimum required limits or higher specified limits).
• Will be screened for Tuberculosis (TB) as part of Humana's Tuberculosis (TB) screening program.

Preferred Qualifications

• Certified Case Manager (CCM).
• Previous experience working in a managed care field.
• 5 or more years of previous management/supervisor level experience.
• Experience with Medicaid Long Term Care.
• Bilingual (fully fluent) in English and Spanish.

Company Information

This role is part of Humana's Driver Safety program. This role is considered member facing.