Manager, Care Management

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Oversee teams comprised of nurses, care coordinators, and behavioral health experts tasked with care management.

• Supervise, guide, and assess healthcare professionals to guarantee effective care coordination.

• Facilitate cross-functional collaboration through briefings and departmental meetings.

• Maintain communication with departmental leaders to ensure alignment and operational efficiency.

• Identify members suitable for case management and/or disease management initiatives.

• Monitor activities related to case management, post-discharge calls, discharge planning, and pre-assessment of elective admissions.

• Formulate system-wide recommendations, report trends, and implement measures to manage those trends.

• Create audit plans and tools to ensure compliance with state contracts and performance metrics.

• Develop reporting tools in collaboration with leadership to assess clinical performance.

• Conduct interviews, hire, mentor, evaluate, coach, and manage the performance of a diverse care coordination team.

• Facilitate onboarding for new associates and coordinate human resources tasks, software, hardware, supplies, and support technologies.

• Track staff performance against service, utilization, and care coordination benchmarks.

• Perform field-based oversight visits and meetings with members, families, community partners, and care teams.

• Travel approximately 25% and attend occasional onsite meetings at Humana Illinois locations.

• Manage up to 15 direct reports.

⛳️ Requirements

• Candidates must reside in Illinois, specifically in Cook County, within the specified ZIP codes or within a 10-mile radius of those ZIP codes.

• Active, unrestricted Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or Licensed Clinical Professional Counselor (LCPC) license in Illinois.

• A minimum of five (5) years of professional experience in the healthcare industry and/or care management.

• At least two (2) years of leadership experience.

• Proficient in using electronic information applications/software programs, including electronic medical records.

• Skilled in analyzing and interpreting data trends.

• Willingness to travel throughout Illinois.

• Advanced degree in nursing or a health-related business field (preferred).

• Certified Case Manager (CCM) certification (preferred).

• Previous experience in managed care (preferred).

• At least five (5) years of management or supervisory experience, including hiring, training, mentoring, and coaching associates (preferred).

• Familiarity with healthcare quality measures such as STARS and HEDIS and/or clinical program monitoring/evaluation (preferred).

• Knowledge of community health and social service agencies and resources (preferred).

• Bilingual or multilingual capabilities, including English/Spanish, Arabic, Vietnamese, Amharic, Urdu, or another language (preferred); must be able to speak, read, and write both languages without limitations and assistance.

• Valid state driver’s license.

• Personal vehicle liability insurance that meets applicable minimum requirements.

• Minimum home internet speeds of 25 Mbps download and 10 Mbps upload.

• Dedicated workspace free from ongoing interruptions to protect member PHI/HIPAA information.

• Willingness to undergo TB screening.

• Willingness to complete the Interagency Language Rating (ILR) test if applicable.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Remote work arrangement.

• Flexible work schedule based on business needs.