Manager, Care Management - Stars
New
H
HumanaHealthcare management
United StatesFull-TimeManager
Salary$86,300 - $118,700 per year
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Job Details
- Experience
- 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
- Required Skills
- Microsoft Office
Requirements
- Hold an active, unrestricted Registered Nurse license with no disciplinary action.
- Have compact licensure.
- Have 5 or more years of RN experience.
- Have 3 or more years of experience in case management.
- Have 1 or more years of data-driven leadership experience, including analyzing performance, identifying trends and risks, and implementing measurable improvement plans.
- Demonstrate strong computer proficiency in Microsoft Office programs and the 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 coaching, motivating, developing, and holding associates accountable.
- Preferred: Experience in managed care, Medicare Stars, quality improvement, telephonic member outreach, care-gap closure, or related member engagement programs.
- Demonstrate effective communication and interpersonal skills, organizational and time-management skills, and problem-solving and decision-making skills.
Responsibilities
- Lead and coach associates conducting telephonic, Stars-focused member outreach.
- Provide feedback and development through one-on-ones, team meetings, call listening, and outreach reviews.
- Ensure associates identify member needs 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.
- Collaborate with Enterprise Stars, quality, operations, analytics, and other stakeholders to improve performance and resolve barriers.
- Analyze performance, quality, and operational data; implement measurable improvement plans.
- Serve as an escalation resource for complex member needs, referrals, outreach barriers, associate concerns, and operational issues.
- Support audit readiness, compliance, onboarding, training, mentoring, and ongoing education.
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