Manager, Care Management (Physical Health & Behavioral Health) – Ohio Medicaid

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Cincinnati, OH




Humana Healthy Horizons in Ohio is seeking Managers of Care Management (Physical Health & Behavioral Health) who will lead our physical or behavioral health care management operations and staff to ensure timely and culturally-competent delivery of care, services, and supports in compliance with Ohio Department of Medicaid (ODM) contractual requirements and industry best practices.


Essential Functions and Responsibilities:

  • Supervise care management personnel and oversee all care management functions, including assessment, care planning, and care coordination.
  • Lead development of care management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
  • Collaborate with internal departments, providers, and community partners to support the delivery of high-quality care management services, including introducing innovative approaches to care coordination.
  • Oversee the processes for comprehensive enrollee assessments to identify their individual needs.
  • Monitor and maintain staffing levels to meet care and service quality objectives.
  • Support orientation and training of staff.
  • Conduct timely evaluations of direct reports and provide regular opportunities for professional development.
  • Influence and assist corporate leadership in strategic planning to improve effectiveness of case and disease management programs for physical health and behavioral health.
  • Collect and analyze performance reports on care management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership

Oversee Care Management staff to ensure the following:

  • Utilize a holistic, enrollee-centric approach to engage and motivate enrollees and their families through recovery and health and wellness programs.
  • Perform clinical intervention through the development of a care plan specific to each enrollee based on clinical judgement, changes in enrollees’ health or psychosocial wellness, and identified triggers.
  • Communicate regularly with enrollees/families, physicians, and facilities/agencies to assure optimal quality patient care and effective operations.
  • Collaborate with relevant internal and external partners to coordinate seamless transitions for enrollees from inpatient settings to community-based services.

Required Qualifications

  • Must reside in the state of Ohio.
  • Licensed Registered Nurse (RN) or Licensed Behavioral Health Professional (LSW, LISW, LISW-S, LPC, LPCC or LPCC- S) in the state of Ohio, with no disciplinary action.
  • Minimum Five (5) years’ experience working in the healthcare setting.
  • Minimum two (2) years of management/supervisory experience.
  • Experience in physical health case management or behavioral health case management.
  • For Behavioral Health, C.M. Manager Only: Must have a Child and Adolescent Needs & Strengths (CANS) certification or able to obtain one within 60 days of hire.
  • Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  • Ability to work independently under general instructions and with a team.
  • This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  • This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
  • Must have the ability to provide a high-speed DSL or cable modem for a home office.
  • A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  • Satellite and Wireless Internet service is NOT allowed for this role.
  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  • Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Preferred Qualifications

  • Bachelor’s degree in nursing, health administration, or related field.
  • Certified Case Manager (CCM).
  • Bilingual – Fluency in Spanish or Somali.
  • Experience serving Medicaid, TANF, and/or CHIP populations.

Additional Information

  • Typical Work Days/Hours: Monday – Friday; 8:00am – 5:00pm.
  • Travel: Up to 25% in-state travel.
  • Direct Reports: Up to 15 associates.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours