Manager, Care Management – Stars

Job not on LinkedIn

🔥 3 minutes ago

🇺🇸 United States – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 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 associates conducting targeted telephonic outreach to help members close care gaps, identify health and social needs, and connect with resources • Provide leadership and coaching through one-on-one meetings, team meetings, call listening, and outreach reviews • Ensure associates identify needs beyond the initial outreach purpose and triage or refer members to clinical, social, or community resources • Set expectations and manage performance across outreach, care-gap closure, productivity, documentation, attendance, compliance, member experience, and health outcomes • Translate Stars priorities and measurement requirements into team actions • Monitor results and adjust outreach strategies to improve engagement, team performance, care-gap closure, and Stars outcomes • Collaborate with Enterprise Stars, quality, operations, analytics, and stakeholder teams • Use performance, quality, and operational data to identify trends, risks, barriers, and coaching needs • Implement measurable action plans to improve associate performance and Stars results • Serve as an escalation resource for complex member needs, referrals, outreach barriers, associate concerns, and operational issues • Communicate performance concerns, risks, barriers, and recommendations on leadership calls • Support audit readiness and address performance or compliance concerns • Support onboarding, training, mentoring, and ongoing education on Stars measures and care-gap workflows • Connect daily team work to enterprise goals, member experience, and health outcomes • Report directly to the Associate Director of Care Management

🎯 Requirements

• Active, unrestricted Registered Nurse license with no disciplinary action • Compact licensure required • 5 or more years of RN experience • 3 or more years of experience in case management • 1 or more years of data-driven leadership experience, including analyzing performance, identifying trends and risks, and implementing measurable improvement plans • Strong computer proficiency in Microsoft Office programs • Demonstrated ability to learn and navigate multiple software applications • 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: Previous experience in managed care, Medicare Stars, quality improvement, telephonic member outreach, care-gap closure, or related member engagement programs • Effective communication and interpersonal skills • Strong organizational and time-management skills • Solid problem-solving and decision-making skills • Ability to embrace ambiguity and change • Ability to manage competing priorities and adapt quickly in a fast-paced environment • Home internet with at least 25 Mbps download and 10 Mbps upload speed • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information • Florida applicants from a Florida work location must complete Florida Level 2 background screening

🏖️ 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 • Occasional travel to Humana offices for training or meetings