Humana is seeking an RN Care Manager Lead to guide a team of nurses in delivering coordinated, member centered care management. This role oversees complex case management, care planning, and utilization review to improve health outcomes for Medicare and Medicaid members. The Lead collaborates with physicians, interdisciplinary teams, and community resources to close care gaps, reduce avoidable admissions, and optimize quality metrics. Responsibilities include mentoring RNs, monitoring caseloads and workflows, using analytics and EMR systems, ensuring regulatory compliance, and driving continuous improvement in clinical and member experience results. Responsibilities Lead and mentor a team of RN care managers delivering member-centered care management Perform complex case management, including assessment, care planning, and follow-up Collaborate with physicians and interdisciplinary teams to coordinate services and close care gaps Use EMR and analytic tools to monitor outcomes, risk, and utilization trends Ensure adherence to regulatory, quality, and documentation standards Support utilization management to reduce avoidable admissions and readmissions Monitor team caseloads, workflows, and productivity metrics Provide clinical escalation support and guidance on high-risk cases Drive continuous improvement initiatives in quality, cost, and member experience Educate members and caregivers on conditions, medications, and available resources Required Skills Care management and case management Clinical assessment and care planning Utilization review and management Electronic Medical Record (EMR) systems Data and outcomes analysis Knowledge of Medicare and Medicaid regulations Population health and chronic disease management Team leadership and staff mentoring Interdisciplinary care coordination Member and caregiver education