Remote Utilisation Management​/Case Management leader; RN​/Physician-advisor - AI Trainer

The Manager, Care Management leads teams of nurses, social workers, behavioral health professionals, and care management support professionals responsible for the care management of Medicaid members in Humana's Illinois market. The Manager, Care Management follows guidelines and departmental procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

• Support and enhance a care management model that leverages extenders (e.g., CHWs, peer support specialists, housing advocates) to address social determinants of health for Medicare-eligible adults.
• Promote culturally responsive, trauma-informed, and person-centered approaches across all care management activities.
• Foster partnerships and collaboration between Care Management and community-based organizations, aging services, housing providers, and public agencies.
• Monitor program performance and use data to evaluate impact, identify gaps, and drive continuous improvement.
• Align departmental processes and performance with market and enterprise objectives to control cost and improve operational efficiencies for existing product lines.
• Collaborate with internal teams and external partners to ensure seamless integration of non-clinical support associates into care planning and service delivery. Assist in coordinating effort between support departments within the organization.
• Assure departmental compliance with applicable federal, state, and contractual requirements and standards.
• Create a productive and positive department through written and verbal communication, briefings and team meetings, and collaboration with other Care Management leadership.
• Develop and maintain policies and procedures that support consistent, high-quality service delivery across the system of care and contribute to the organization's mission of advancing health equity and reducing disparities.
• Support training and capacity-building efforts for care management extenders, including CHWs and peer specialists.
• Assist in resolving individual member issues related to housing, food insecurity, transportation, and other social needs.
• Represent the care management program in collaborative initiatives, advisory groups, and community forums.
• Participate as a member of the management team in promoting Humana's mission for strategic growth and development.
• Fully participate in Humana's Compliance Program, including compliance with Humana's Code of Conduct, policies and procedures, and all applicable Privacy and Security laws.
• Coordinate needed support to operations areas through smooth workflows and cost efficient, quality product delivery.
• Continuously improve customer satisfaction through effective program monitoring to achieve timely and appropriate service delivery and reduced member problems.

• Must reside in Illinois
• Minimum of an Associate's Degree
• Active Registered Nurse (RN) license or Social Work (SW) license
• 5+ years of professional experience
• 2+ years of management or supervisory experience.
• Proficiency in analyzing and interpreting data trends.
• Progressive operational leadership experience
• Strong, demonstrated communication, analytical, problem solving and team playing skills.
• Knowledge of Medicaid/Medicare, and long-term care guidelines, benefits and policies and procedures.
• Demonstrated computer skills in Microsoft Windows, Outlook, Excel, Word as well as other MIS software applications.
• Strong understanding of care management models and the role of extenders in addressing social needs
• Demonstrated ability to lead cross-functional initiatives and collaborate with external partners
• Ability to operate independently and in a team environment.

• Bachelor's degree or advanced degree in nursing or business health field
• Previous experience working in a managed care field
• 5 or more years of previous management/supervisor level experience
• Experience managing or collaborating with community health workers, peer support specialists, or housing programs
• Familiarity with Illinois Medicaid policies and systems

• Workstyle: This is a remote position that requires travel.
• Travel: 50 75% field-based interactions conducting care team oversight visits, meeting with members and/or their families, community partners and other care teams. May need to attend occasional onsite meetings in Humana's Illinois locations.
• Mileage Reimbursement for Travel: Mileage reimbursement is provided for work-related travel. Eligible mileage includes travel from your home to your first work location, travel between client or assignment locations during the workday, and travel from your final work location back to your home.
• Typical Workdays and
  
  Hours:
  
  Monday - Friday 8:00 AM - 5:00 PM CST. May need to be provide flexibility with work schedule based on business needs.
• Direct Reports: Up to 15 associates.
• Language Assessment Statement: Any Humana…