Manager, Care Management - Stars

Humana; United States; Remote; USD 100,000 - 150,000; Full time

Job summary

Humana seeks a Manager, Care Management to lead a Stars initiative team dedicated to telephonic member outreach, closing care gaps, and identifying health and social needs. This remote role reports to the Associate Director of Care Management and drives quality, accountability, and member-centered outcomes.

You will coach associates, triage needs, and collaborate across enterprise teams to optimize performance and Stars results.

Qualifications

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

Responsibilities

• Lead a Stars-focused Care Coaches team delivering telephonic outreach to close care gaps and identify needs.
• Provide leadership with regular 1:1s, team meetings, call listening, and outreach reviews to ensure quality.
• Triage or refer members to clinical, social, or community resources as needed.
• Set clear expectations, manage performance on outreach, care-gap closure, productivity, documentation, attendance, and compliance.
• Translate priorities into team actions; monitor results and adjust outreach strategies to improve engagement and outcomes.
• Collaborate with Enterprise Stars, quality, operations, analytics, and other teams to improve performance and impact.
• Use data to identify trends and risks and implement measurable action plans to improve performance.
• Serve as escalation resource for complex member needs and operational issues.

Skills

Data-driven leadership

Microsoft Office proficiency

Education

RN license

Bachelor/Master in nursing or related field

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.

Use your skills to make an 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 follo