Manager, Care Management – RN or SW, LTSS/HCBS

🔥 19 hours ago

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Lead teams of nurses and behavioral health professionals responsible for care management • Oversee Michigan LTSS and HCBS care management operations • Ensure compliance with Medicaid contracts, CMS requirements, Humana policies, and state contractual requirements • Monitor quality and timeliness of LTSS assessments, reassessments, and care plans • Ensure compliance with NFLOCD requirements and regulatory timeframes • Oversee InterRAI IHC assessment processes, documentation standards, audits, and staff competency development • Use operational and clinical data to identify trends and quality improvement opportunities • Support staff managing complex member needs, behavioral health concerns, and social determinants of health • Collaborate with Quality, Compliance, Provider Relations, Network, Medical Directors, and State partners • Lead audit preparation, readiness reviews, and state monitoring activities • Provide leadership to Field Care Managers, Nurse Team Leads, Community Health Workers, and support staff • Manage 13 direct reports

🎯 Requirements

• Active Michigan RN or Social Work license • Must reside in Michigan • 2+ years of experience in care management, LTSS, and HCBS • 2+ years of leadership experience managing clinical or field-based teams • Strong knowledge of Medicaid regulations and person-centered planning • Knowledge of Nursing Facility Level of Care Determination (NFLOCD) requirements, InterRAI assessments, and LTSS eligibility processes • Experience interpreting regulatory and contractual requirements in managed care environments • Experience using performance metrics and operational reporting • Preferred: Masters degree in Nursing, Social Work, Public Health, Healthcare Administration, or related field • Preferred: Certified Case Manager (CCM) • Preferred: Experience leading Medicaid LTSS, HCBS, or managed care operations • Preferred: Experience supporting dual-eligible, waiver, or HIDE SNP populations • Preferred: Bilingual Spanish, Arabic, or Chaldean Neo-Aramaic • Home internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual 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 • Remote work • Occasional travel to Humana offices for training or meetings