Manager, Clinical Care Integration

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The Role

The Care Integration Team Manager is responsible for managing a team of nurses, care coaches, and social workers (referred to as “Care Integration Team or CIT) who engage high needs patients using an interdisciplinary team-based approach to ensure patients receive the individualized care and services they need to reach optimal health. The Manager provides direct oversight of market-based Care Integration Team operations, including care management program execution, team performance, staff development, and patient engagement. The Manager also maintains a direct caseload of high-risk patients while balancing leadership, operational, and strategic responsibilities. The Manager is responsible for building strong partnerships with clinical and operational market leaders on the Care Integration Team program and strategic opportunities for managing populations and coordinating care to improve patient outcomes and reduce avoidable acute and post-acute care utilization.

The Manager role is hybrid with travel requirements to local clinics and communities (e.g., for market leader meetings, in-clinic case rounds, team member shadowing/coaching, home visit ride-along) and to preferred healthcare facilities in the community, alongside clinical market leader, to develop clinical partnerships for timely access to patient information, clinical collaboration on patient care, and patient centered resources.

As a guideline, this role involves spending 20% of the time on direct patient management, 70% of time on team management, operational excellence and program delivery, quality oversight, and staff development, and 10% of time on market relationships and community partnerships.

Major Duties and Responsibilities  

• Leads daily operations of the Care Integration Team, including productivity, quality, recruiting/hiring, training, and performance management.  

• Ac countable for market Care Integration Team’s achievement of program   goals   and expectations   across   productivity,   adherence to standard processes,   clinical   quality,   patient engagement ,   utilization , and financial measures .   Monitors   and guides team   performance using performance dashboards and metrics .   D evelops and implements action plans to meet goals.  

• Establishes   clear   performance   expectations   and holds Associates accountable through   regular  1:1  feedback, audits  / shadowing , SMART goals, coaching , and   corrective action plans when   needed.   Builds team member capabilities through individual and group- based feedback   and training sessions .   Recognizes and celebrates   strong performance .  

• Ensures clinical program integrity at the market level and addresses improvement opportunities, escalating to Clinical Care Integration Director as   appropriate .  

• Interviews, hires, onboards, trains, and   retains   Care Integration Team associates.  

• Manage s a   caseload of   high risk   patients   including   performance of   transition al   and longitudinal care management,   care planning,   multidisciplinary case rounds,   and   patient home visits .   Supports team members in reviewing patient cases ,   assessing drivers of   utilization ,   and developing care plan recommendations for PCP review.  

• Partners with market leaders and key stakeholders to   review   performance   and   develop action plans   to improve operational performance   and reduce   avoidable   acute and post-acute care   utilization .   Prepares and leads regular market leader performance review meetings.   Promotes collaboration and a "one care team” approach to   optimize   management of high- needs   patients.  

• Builds and   maintains   relationships with community partners, including community health organizations,   Centerwell   organizations (home health and pharmacy) , and health care systems   for strong clinical collaboration   to improve patient   experience and   population   health outcomes.  

• Fosters a high-performing, engaged team culture that supports accountability, retention, professional growth, and recognition of achievements.   Ensures   team members understand how their work contributes to program goals.  

Use your skills to make an impact

 

Req uired Qualifications  

• A n active R egistered Nurse ,   or   L icensed Practice Nurse   or   Licensed Vocational Nurse,   or   PharmD   licens ure ,   or   E mergency   M edical   T echnician   certification , or foreign equivalent of Registered Nurse or Medical Doctor license  

• 5 + years of prior nursing , case management,   or   disease   management   experi e nce  

• 2+ years of   leadership   experience  

• Experience with transitions of care management and working with senior   populations  

• Excellent clinical competencies, including knowledge of chronic conditions (e.g., Diabetes, CHF, COPD , CKD )  and related symptoms,   risk factors  /  signs of exacerbations,   disease management interventions ,   and common medications  

• Experience working   in   primary care value - based  / managed   care organizations  

• Proficiency   in analyzing and interpreting data trends  

• Comprehensive knowledge in Microsoft office products  

• Must be passionate about contributing to an organization focused on continuously improving   patient   experience  

• Must provide a   high speed   DSL or cable modem for home office  

• Must have a separate room with a locked door that can be used as home office to ensure you have absolute privacy  

• Driving   required   to   clinics and   community organizations   and   health systems  

Characteristics of the qualified candidate:  

• Pro-active, positive attitude, and comfortable being a change agent  

• Capable of   identifying   root causes of operational issues, problem-solving, and developing action plans  

• Capable of setting SMART goals, aligned with organization, and holding staff accountable for achieving goals.  

• Excellent communication skills, including follow-through communication and the ability to interpret and translate data to tell a story via executive level presentations.  

• A passionate advocate for improving clinician and patient experience and health outcomes through population health management.  

• Relationship management and negotiation skills to ensure key organizational and community partners feel engaged, heard, and respected.  

• Skilled at leading   meetings with Medical and Operations Leaders,   facilitating   interdisciplinary discussions, and driving accountability across cross-functional teams.  

• Demonstrates resilience, adaptability, and professionalism in a fast-paced, evolving environment.  

• Knowledge of community resources, social determinants of health, and health equity strategies.  

 

Preferred Qualifications  

• Knowledge of Athena (E lectronic Medical Record ) and Salesforce  

• Bilingual in English/Spanish with the ability to speak, read and write in both languages without limitations and   assistance  

Additional Information

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. 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.  

 

 

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.

 

$94,900 - $130,500 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.

About Us

 

About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.