Jobs and Careers
HM
Care Manager, Medicare Stars
HMSAUnited Statesfull_timeVerifiedPosted 24 Jun 2026
About the role
- Assessment & Planning
- May conduct comprehensive assessments, which could include physical, psychosocial, and health literacy evaluation, and interprets relevant diagnostic data to identify member and family needs.
- Apply critical thinking skills to analyze complex cases, complete medication reconciliation post-discharge, and determine underlying causes contributing to high costs as applicable. Uses these insights to inform individualized transition/treatment plans and address gaps in care delivery.
- If applicable, partners with and empowers the member to develop an actionable care plan that helps prevent avoidable utilization.
- Care Delivery
- Consistently follows through on all essential tasks and completes them within required timeframes to effectively close care gaps.
- Communicate results to internal and external departments and business partners as applicable.
- Communication & Education
- If applicable, assesses educational needs of members and families, ensuring clear and sufficient information is provided to facilitate active participation in care gap closure.
- Quality Improvement & Leadership
- Engages in quality improvement initiatives, supports leadership in system-level improvements, analyzes dashboard data for program enhancement, and mentors new staff to promote best practices.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
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At least three years of relevant clinical experience in medical-surgical, community or home health care, or equivalent experience in reviewing members' medical care and services.
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Must meet facility specified health screening/annual competency requirements.
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Demonstrates thorough expertise in care transitions with little supervision required.
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Possesses strong documentation and research abilities, can analyze information, make decisions, and communicate effectively both verbally and in writing.
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Displays interpersonal skills, resolves conflicts, and acts with integrity.
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Highly organized, able to multitask independently, fostering adaptability and teamwork.
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Performs well in a fast-paced setting and readily adapts to changes.
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Delivers outstanding customer service to both internal and external clients.
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Utilizes excellent analytical and critical thinking to evaluate medical necessity and the suitability of patient services and treatment individually.
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Safeguards patient privacy in accordance with Federal (HIPAA), organizational, and departmental regulations.
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Clearly communicates with providers and health care teams while building collaborative relationships.
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Intermediate working knowledge in Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.
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Experience with electronic medical records.
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Valid current Hawaii Registered (RN) or Registered Pharmacist (RPh).
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*(upon hire upon hire, proof of licensure to be provided by employee to Human Resources as well as a signed "Clinical Affirmation Statement for RN/LSW" form if applicable)
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Reliable transportation to perform in person (Face to Face) meetings with members in their home or in alternative settings.
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