Manager, Care Management – Stars

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

📋 Description

• Lead team members in targeted telephonic outreach to assist members in closing care gaps, addressing health and social needs, and connecting them with necessary resources.

• Provide leadership and coaching through individual meetings, team discussions, call evaluations, and outreach assessments.

• Ensure team members recognize needs beyond the initial outreach goals and appropriately triage or refer members to clinical, social, or community resources.

• Establish expectations and oversee performance in areas such as outreach, care-gap closure, productivity, documentation, attendance, compliance, member experience, and health outcomes.

• Convert Stars priorities and measurement criteria into actionable steps for the team.

• Monitor outcomes and modify outreach strategies to enhance engagement, team performance, care-gap closure, and Stars results.

• Collaborate with Enterprise Stars, quality assurance, operations, analytics, and various stakeholder teams.

• Utilize performance, quality, and operational data to pinpoint trends, risks, barriers, and coaching requirements.

• Execute measurable action plans aimed at improving associate performance and Stars outcomes.

• Act as an escalation point for complex member needs, referrals, outreach challenges, associate inquiries, and operational issues.

• Communicate concerns regarding performance, risks, barriers, and recommendations during leadership meetings.

• Ensure audit readiness and address any performance or compliance issues.

• Assist in onboarding, training, mentoring, and continuous education related to Stars measures and care-gap workflows.

• Link daily team activities to enterprise objectives, member experience, and health outcomes.

• Report directly to the Associate Director of Care Management.

⛳️ Requirements

• Active, unrestricted Registered Nurse license with no disciplinary actions.

• Compact licensure is required.

• A minimum of 5 years of RN experience.

• At least 3 years of experience in case management.

• A minimum of 1 year of data-driven leadership experience, including performance analysis, trend identification, risk assessment, and implementation of measurable improvement plans.

• Strong proficiency in Microsoft Office programs.

• Proven ability to learn and navigate multiple software applications effectively.

• Preferred: Bachelor’s or Master’s degree in nursing, healthcare administration, business, or a related field.

• Preferred: Three or more years of management or supervisory experience.

• Preferred: Prior experience in managed care, Medicare Stars, quality enhancement, telephonic member outreach, care-gap closure, or similar member engagement initiatives.

• Excellent communication and interpersonal abilities.

• Strong organizational and time management skills.

• Solid problem-solving and decision-making capabilities.

• Ability to adapt to ambiguity and change.

• Capacity to manage competing priorities and adjust swiftly in a fast-paced environment.

• Home internet connection with a minimum of 25 Mbps download and 10 Mbps upload speed.

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

• Florida applicants located in Florida must undergo a Florida Level 2 background screening.

🏝️ Benefits

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

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Occasional travel to Humana offices for training or meetings.