Bilingual Care Manager, Telephonic Nurse 2

Humana•Work at Home - Illinois, IL

2d•$71,100 - $97,800•Remote

About The Position

The Care Manager, Telephonic Nurse 2 works in a telephonic environment to assess and evaluate members’ needs and guide members and families toward resources that support optimal wellness and wellbeing. The role uses strategies to manage members’ physical, environmental, and psychosocial health issues; identifies and resolves barriers to effective care; and monitors progress toward desired outcomes through ongoing assessments and evaluations. The Care Manager may create member care plans and provides health assessments, care planning, and education about chronic conditions and gaps in members’ healthcare plans for an assigned population over the phone. Work assignments are varied and frequently require interpretation and independent decisions about appropriate courses of action. The role requires understanding departmental, segment, and organizational strategy and operating objectives, making decisions about one’s work methods (including occasionally in ambiguous situations), following established guidelines and procedures, and working with minimal direction while receiving guidance as needed. Working hours fall between 8:00 a.m. and 7:00 p.m. Central Time, with core hours primarily 8:00 a.m. to 5:00 p.m. This is a remote position, though occasional travel to Humana offices for training or meetings may be required. Employees working from home must have internet service with at least 25 Mbps download and 10 Mbps upload speeds and a dedicated workspace that protects member PHI/HIPAA information.

Requirements

Bilingual in English and Spanish.
Bachelor’s degree.
3–5 years of clinical acute care experience.
Active Registered Nurse (RN) license in the appropriate state with no disciplinary action.
Comprehensive knowledge of Microsoft Office applications, including Word, Excel, and Outlook.
Passion for contributing to an organization focused on continuously improving consumer experiences.

Nice To Haves

Experience with case management, discharge planning, and patient education for adult acute care.
Knowledge of Milliman or InterQual.
Managed care experience.
Certified Case Manager (CCM).

Responsibilities

Assess and evaluate members’ needs and requirements to support optimal wellness.
Guide members and families toward appropriate care and wellbeing resources.
Manage members’ physical, environmental, and psychosocial health issues using appropriate strategies and techniques.
Identify and resolve barriers that hinder effective care.
Monitor member care through assessments and evaluations to ensure progress toward desired outcomes.
Create member care plans as needed.
Conduct phone-based health assessments, care planning, and education on chronic conditions and gaps in healthcare plans for an assigned member population.
Follow established guidelines and procedures while making decisions about work methods and appropriate courses of action.