Humana is seeking an RN Care Manager Lead to guide a team of nurses in delivering coordinated, member-centered care. In this role, you will oversee complex case management, conduct clinical assessments, and design individualized care plans that improve health outcomes and reduce unnecessary hospitalizations. You will mentor and coach RN care managers, monitor quality and utilization metrics, and collaborate with physicians, social workers, and community partners. The Lead partners with analytics and pharmacy teams to identify care gaps, drives process improvements, ensures regulatory and documentation compliance, and supports a culture of inclusion, continuous learning, and clinical excellence. Responsibilities Lead and mentor RN care managers in daily case management activities Perform comprehensive clinical assessments for members with complex needs Develop and oversee individualized care plans to improve outcomes Coordinate care with physicians, social workers, and community partners Monitor utilization, quality, and performance metrics for the care team Ensure accurate, timely clinical documentation and regulatory compliance Identify care gaps using data and partner with analytics teams on interventions Support process improvement initiatives to enhance care coordination Provide clinical guidance and escalation support for high-risk cases Promote a member-focused, inclusive, and collaborative team culture Required Skills Clinical assessment and nursing judgment Care and case management Utilization management Chronic disease management Electronic health record (EHR) systems Data and quality metrics interpretation Interdisciplinary care coordination Regulatory and compliance knowledge (Medicare/Medicaid) Team leadership and coaching Member and provider communication