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Manager, Care Management-Medicaid/Maternity

Become a part of our caring community and help us put health first
 

The Manager, Care Management leads our HumanaBeginnings maternity team focusing on assisting members achieve optimal health outcomes and reduce high risk pregnancies. The Manager, Care Management works within state contractual guidelines; applies advanced clinical knowledge to solve moderately complex care gaps; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities of the role include:

  • Oversees the assessment and evaluation of pre and post-partum Medicaid enrollees' needs and requirements to achieve and/or maintain optimal wellness.
  • Oversight and management of a team of Care Managers operating within our HumanaBeginnings maternity model approach utilizing resources, evidence-based practice to supports the needs of members through an interdisciplinary-multidisciplinary care team.
  • Makes decisions that are typically related to high-risk maternity, resources, approach, and tactical operations for projects and initiatives involving maternity departmental area.
  • Requires cross departmental collaboration and conducts briefings and area meetings; maintains maternity related state and compliance reporting; and works in contact with other managers across the department.


Use your skills to make an impact
 

Required Qualifications

  • Bachelor's Degree in Nursing
  • 5 or more years of nursing experience
  • Active Registered Nurse (RN) license in good standing
  • Must reside within a 2-hour radius of Louisville, KY
  • Proficiency in analyzing and interpreting data trends.
  • Progressive business consulting and/or operational leadership experience
  • Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint

Preferred Qualifications

  • 2 or more years of management experience
  • Maternity related experience
  • Case Management experience, managing member's health outcomes
  • Previous experience working in a managed care field
  • Bilingual

Additional Information

  • Workstyle: Hybrid Home - Quarterly travel to the Louisville, KY office
  • Typical Work Days/Hours: Monday through Friday, 8:00 am – 5:00 pm EST.

WAH Internet Statement

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.
  • Satellite, cellular and microwave connection can be used only if approved by leadership.
  • Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

  • Health benefits effective day 1
  • Paid time off, holidays, volunteer time and jury duty pay
  • Recognition pay
  • 401(k) retirement savings plan with employer match
  • Tuition assistance
  • Scholarships for eligible dependents
  • Parental and caregiver leave
  • Employee charity matching program
  • Network Resource Groups (NRGs)
  • Career development opportunities

HireView

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.


About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.


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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

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Average salary estimate

$102500 / YEARLY (est.)
min
max
$86300K
$118700K

If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.

What You Should Know About Manager, Care Management-Medicaid/Maternity, Humana

Join Humana as a Manager in Care Management, where you'll lead our dedicated HumanaBeginnings maternity team from the comfort of your home in Kentucky! In this vital role, you will focus on empowering Medicaid members to achieve their optimal health outcomes and support mothers through challenging high-risk pregnancies. Leveraging advanced clinical knowledge, you will oversee the assessment and evaluation processes for pre and post-partum Medicaid enrollees, striving to help them maintain their wellness every step of the way. Your leadership will guide a passionate team of Care Managers, allowing you to collaborate closely with various departments and manage essential compliance reporting. You'll have the opportunity to not only influence high-risk maternity initiatives but also make critical decisions that directly impact members' lives. The position offers flexibility via a hybrid work model, requiring occasional visits to our Louisville office, and typical work hours from Monday to Friday. Humana values your contributions and supports your growth through competitive benefits, including health benefits from day one, flexible time off, and career development resources. If you're an experienced nurse with a deep passion for maternal health, ready to make a significant impact in your community, we would love to hear from you!

Frequently Asked Questions (FAQs) for Manager, Care Management-Medicaid/Maternity Role at Humana
What are the main responsibilities of the Manager, Care Management at Humana?

As the Manager, Care Management at Humana, your primary responsibilities include overseeing the assessment and evaluation of pre and post-partum Medicaid enrollees, leading a team of Care Managers within the HumanaBeginnings maternity framework, and making decisions related to high-risk maternity cases. You'll also be involved in cross-departmental collaborations and will ensure compliance with state regulations and reporting requirements.

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What qualifications are needed for the Manager, Care Management position at Humana?

To qualify for the Manager, Care Management role at Humana, you need a Bachelor's Degree in Nursing and a minimum of 5 years of nursing experience. An Active Registered Nurse (RN) license in good standing is required, along with strong skills in analyzing data trends and previous leadership experience. Maternity-related and case management experience is preferred.

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What are the work-from-home requirements for the Manager, Care Management position at Humana?

While the Manager, Care Management role at Humana is remote, it requires employees to have reliable internet service with a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Additionally, a dedicated workspace free from interruptions is necessary to protect confidential member information.

Join Rise to see the full answer
What is the pay range for the Manager, Care Management position at Humana?

The compensation for the Manager, Care Management at Humana ranges between $86,300 to $118,700 annually. This is reflective of a full-time position with opportunities for bonus incentives based on individual and company performance. Individual pay may vary based on skills, knowledge, and experience.

Join Rise to see the full answer
What benefits does Humana offer for the Manager, Care Management role?

Humana offers an extensive benefits package for the Manager, Care Management position that includes health benefits effective from day one, paid time off, a 401(k) retirement plan with employer matching, tuition assistance, and opportunities for career development. Humana places a strong emphasis on the whole-person well-being of its employees, enhancing their work-life balance.

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Common Interview Questions for Manager, Care Management-Medicaid/Maternity
Can you describe your experience managing a maternity care team?

When answering this question, highlight your past leadership experiences, specific challenges you faced while managing a maternity care team, and how you utilized evidence-based practices to enhance patient outcomes. Discuss any successful initiatives you led and the impact they had on team performance and member care.

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How do you approach cross-departmental collaboration in healthcare?

Focus on explaining your strategies for maintaining open communication and relationship-building with other departments. You can also mention specific tools or methodologies you use to facilitate collaboration, and provide examples of past successes achieved through effective teamwork.

Join Rise to see the full answer
What strategies do you employ to assess the needs of high-risk maternity patients?

Detail your approach to conducting thorough assessments, including the tools and frameworks you use to evaluate patient needs. Discuss how you prioritize interventions and coordinate care with interdisciplinary teams, ensuring that all aspects of patient health are addressed.

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How do you ensure compliance with state regulations for Medicaid enrollees?

Explain your methods for staying informed about state regulations and your experience with compliance processes. Share examples of how you've navigated compliance challenges in the past and any systems you've implemented to monitor adherence to these regulatory requirements.

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Tell us about a time you used data analysis to improve health outcomes.

Provide a specific example where you analyzed data trends relevant to maternal health. Discuss how you identified gaps, implemented changes based on your analysis, and measured the outcomes to showcase your effective data-driven decision-making.

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What is your management style, and how does it benefit your team?

Describe your management style, whether it's collaborative, hands-on, or results-oriented. Emphasize how this style promotes team morale, encourages professional development, or improves team productivity, backing it up with examples of successful leadership moments.

Join Rise to see the full answer
How do you handle conflicts within your healthcare team?

Share a thoughtful approach to conflict resolution that involves active listening, mediation, and problem-solving. Provide an example where you successfully resolved a conflict, focusing on the techniques you used and the outcome achieved.

Join Rise to see the full answer
Why do you want to work for Humana in this Manager role?

When answering this question, express your passion for maternal health and how Humana's mission aligns with your personal values and professional goals. Mention specific attributes of Humana you admire, like their commitment to community health and innovative care models.

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How do you ensure patient confidentiality and HIPAA compliance?

Discuss your understanding of patient confidentiality requirements, your practices for safeguarding sensitive information, and any training you've undergone on HIPAA compliance. Share your commitment to fostering a culture of confidentiality within your team.

Join Rise to see the full answer
What tools or software are you familiar with for care management?

Reflect on your experience with tools relevant to care management and data analysis, specifically within the Medicaid framework. Talk about any software you've used for case management, reporting, or communication, and how these tools have improved patient care.

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Since 1961, Humana has been committed to helping people live healthy and happy. Our approach is simple—offer personalized care from people who care. We do this by listening to our members and creating solutions to help them reach the best version ...

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Full-time, hybrid
DATE POSTED
April 15, 2025

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