The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
- The LTSS Manager, Care Management oversees Home and Community-Based Services (HCBS) and Long-Term Services and Supports (LTSS) care management operations for Michigan Medicaid members.
- Responsible for compliance with state contractual requirements, person-centered planning, LTSS assessments, NFLOCD activities, and care coordination supporting members in the least restrictive setting.
- Provides leadership to Field Care Managers, Nurse Team Leads, Community Health Workers, and support staff.
Position Responsibilities
- Provide leadership and oversight of Michigan LTSS and HCBS care management operations.
- Ensure compliance with Medicaid contracts, CMS requirements, and Humana policies.
- 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.
Use your skills to make an impact
Required Qualifications
- 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 Qualifications
Masters degree in Nursing, Social Work, Public Health, Healthcare Administration, or related field.
Certified Case Manager (CCM).
Experience leading Medicaid LTSS, HCBS, or managed care operations.
Experience supporting dual-eligible, waiver, or HIDE SNP populations.
Bilingual Spanish, Arabic, or Chaldean Neo-Aramaic
Additional Information
- Schedule/Time Zone: Monday through Friday, 8:00 AM 6 5:00 PM.
- Work Location: Michigan
- Work Style: Remote
- Travel Requirements: Approximately 5% travel for in-person meetings and team events
- Number of Direct Reports: 13 direct reports
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees9 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.
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.
