Manager, Care Management - Stars

Humana Inc; United States; Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote position

Job summary

Humana Inc. seeks a Manager, Care Management to lead a Stars-focused team delivering telephonic member outreach and care-gap closure. You will guide associates, promote quality, and adapt to evolving Stars priorities, reporting to the Associate Director of Care Management.

You will shape member-centered care delivery, identify health and social needs, and coordinate with clinical and community resources to improve outcomes. Remote position on a dedicated Stars team.

Qualifications

• Active, unrestricted RN license with no disciplinary action.
• 5+ years RN experience and 3+ years in case management.
• 1+ year of data-driven leadership experience with measurable improvement plans.
• Strong computer proficiency and ability to learn multiple software apps.

Responsibilities

• Provide leadership and coaching for associates conducting telephonic outreach.
• Foster quality via feedback, 1:1 meetings, and performance reviews.
• Identify member needs beyond outreach and refer to clinical or social resources.
• Translate priorities into team actions and monitor performance trends.
• Collaborate with Enterprise Stars, quality, analytics, and operations teams.

Skills

Leadership

Team coaching

Data-driven decision-making

Communication

Education

Bachelor's or higher in Nursing

Master's degree preferred

Tools

Microsoft Office

Job description

Become a part of our caring community

The Manager, Care Management leads associates who conduct targeted telephonic outreach to help members close care gaps, identify additional health and social needs, and connect with appropriate resources. This data-driven leader thrives in leading a team focused on promoting quality, accountability, and driving member-centered outcomes. As manager of Care Management on the Stars Initiative team, you will bring forward practical solutions, speak up when barriers or opportunities arise, and guide the team through changing Stars priorities and business needs. This is a remote position on a dedicated team of Stars managers, and you will report directly to the Associate Director of Care Management.

Make a Meaningful Impact

This mission-driven role offers the opportunity to lead a team of Stars-focused Care Coaches who help improve members' health by closing care gaps, identifying health concerns early, and connecting members with support. This support may slow the progression of chronic conditions. The manager will help shape how Humana delivers high-quality, member-centered care within an evolving healthcare ecosystem.

What Success Looks Like:

You will provide leadership and coaching for associates who conduct telephonic, Stars-focused member outreach. You will foster excellence in quality by offering feedback and development opportunities, including regular one-on-one meetings with direct reports, team meetings, call listening, and outreach reviews to foster excellence in quality. You will ensure associates identify needs beyond the initial outreach purpose and triage or refer members to appropriate clinical, social, or community resources. You will inspire an engaged, inclusive, and accountable team by setting the standard for how associates show up; Promote professional behaviors, recognize contributions, foster collaboration, and support development. You will set clear expectations and manage performance across both quantity and quality. This includes managing outreach, care-gap closure, productivity, documentation, attendance, professional behavior, compliance, member experience, and health outcomes. You will translate Stars priorities, measurement requirements, and performance opportunities into clear team actions; monitor results and adjust outreach strategies to improve member engagement, team performance, care-gap closure and Stars outcomes. You will collaborate across multiple enterprise partner teams, including Enterprise Stars, quality, operations, analytics, and other stakeholder teams to identify opportunities to improve performance and impact, resolve barriers, and align outreach strategies according to enterprise priorities. You will use performance, quality, and operational data to identify trends, risks, barriers, and coaching needs; then implement measurable action plans that improve associate performance in outreach effectiveness, workflows, care-gap closure, and Stars results. You will be an escalation resource for complex member needs, referrals, outreach barriers, associate concerns, and operational or process issues requiring manager intervention. You will communicate on leadership calls, constructively raising Stars performance concerns, risks, barriers, and escalations while presenting recommendations and opportunities. You will support audit readiness and address performance or compliance concerns by promoting applicable policies, privacy requirements, documentation standards, and quality expectations. You will support onboarding, training and mentoring, and ongoing education on Stars measures, outreach expectations, care-gap workflows, member-needs identification, and referral processes. You will connect the team's daily work to broader enterprise goals, Stars performance, member experience, and health outcomes; Help associates understand how their contributions create meaningful business and member impact.

Required Qualifications

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 and demonstrated ability to learn and navigate multiple software applications.

Preferred Qualifications

A Bachelor’s or Master’s degree in nursing, healthcare administration, business, or a related field.

Three or more years of management or supervisory experience, with demonstrated success coaching, motivating, developing, and holding associates accountable.

Previous experience in managed care, Medicare Stars, quality improvement, telephonic member outreach, care-gap closure, or related member engagement programs.

Additional Information

Qualified candidates should have the following key attributes: Effective communication and interpersonal skills, and ability to build rapport with direct reports, internal teams, and other stakeholders. Strong organizational and time-management skills. Solid problem-solving and decision-making skills. Ability to embrace ambiguity and change while confidently leading associates through evolving priorities and shifting business needs. Ability to manage competing priorities, use sound judgement and adapt quickly in a fast-paced environment.

Work at Home Requirements:

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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Florida Background Screening Requirements:

Notice for candidates applying to this position from a Florida work location, including Florida home-based work location. This position is subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse. For information about the screening process and requirements, visit: https://info.flclearinghouse.com.

Scheduled Weekly Hours 40 Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.