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The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

This is a remote position and will require 50-75% travel in Wayne County or Macomb County.

Must reside in Michigan with capability to drive to Wayne County or Macomb County.

The Manager, Care Management oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.

The Manager of Care Management

• Requires cross-departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
• Responsible for and oversees 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.
• Monitor performance of staff including service performance and adherence to established care coordination benchmarks.
• Identify members for specific case management and / or disease management activities.
• Develop 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 work force.
• Onboard new staff including but not limited all pre-employment human resource tasks, ordering of software, hardware, supplies and support technologies.
• Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions.

Use your skills to make an impact
 

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 to include 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 providing supporting 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 you have absolute and continuous privacy while you work
• This role is part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
• This role is considered member facing and is part of Humana Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.​

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

WAH Internet Statement

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.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirement