Care Manager, Telephonic Nurse

CenterWell

5d•$71,100 - $97,800•Remote

About The Position

This is a work-from-home telephonic Registered Nurse position. The Care Manager, Telephonic Nurse helps ensure continuity of care for patients transitioning into and out of CenterWell Home Health services. The role requires knowledge of post-acute levels of care and expertise in CenterWell Home Health services, including home health, hospice, and palliative care. The nurse communicates with the clinical team and helps facilitate follow-up for patients who need additional services. The position is full time at 40 hours per week, scheduled for eight-hour shifts, five days per week. The regular schedule is Monday through Friday, 9:00 a.m.–5:30 p.m. EST, with required coverage every third weekend on Saturday and Sunday, 9:00 a.m.–5:30 p.m. EST; weekend work allows days off during the week. A rotating holiday schedule is required. Training may be scheduled outside the advertised shift, and schedules or shifts may change based on patient-care needs and business demands. Occasional travel to Humana offices for training or meetings may be required. The position reports directly to the Manager, Care Management. It advocates for patients by navigating post-acute care options, Medicare coverage, billing issues, and healthcare resources; educating patients about available services; determining appropriate clinical levels of care; and matching patients with service locations or alternatives. It supports referrals and admissions, follows referral and admission outcomes, and works toward patient satisfaction and department performance goals. The posted annual base-pay range is $71,100–$97,800. Humana offers medical, dental, and vision benefits; a 401(k) retirement savings plan; paid time off and holidays; paid parental and caregiver leave; short- and long-term disability; life insurance; and other benefits.

Requirements

Associate degree required; a BSN is preferred.
Compact state RN license required; additional state licenses may be required based on business needs.
At least 3 years of post-acute nursing experience.
Knowledge of home health, hospice, and palliative care services.
Ability to learn and master information about client locations and services.
Analytical and problem-solving skills.
Excellent verbal and interpersonal skills.
Ability to communicate with empathy over the phone.
Fluency in reading, writing, and speaking English.
Current CPR certification.
For work at home, self-provided internet must have at least 25 Mbps download and 10 Mbps upload speed; wireless, wired cable, or DSL is suggested. Humana may require an internet service upgrade if needed for business requirements.
Work from a dedicated space without ongoing interruptions to protect member PHI and HIPAA information.

Nice To Haves

BSN.
Home health or hospice experience.

Responsibilities

Represent CenterWell Home Health in supporting patients discharged from service or in need of post-acute services.
Help patients navigate post-acute care offerings, Medicare coverage, billing issues, and healthcare resources.
Provide patient options and education using available tools and methods, including information about sites of service, specialty offerings, and post-acute care.
Handle customer issues such as location lookup, directions, and complaints.
Determine clinical level of care based on discussions, medical records, and other relevant clinical data.
Match patients’ needs to a service-site location or identify and provide alternative services when the preferred service is unavailable.
Advocate for patients throughout the referral process to support timely responses and maximize referral-to-admission conversion.
Follow up on and track referral and admission outcomes.
Maintain awareness of department performance objectives, meet standards, and help achieve patient satisfaction goals.
Assist with admissions by acting as an ambassador for patients who meet admissions requirements.
Help place each patient in the appropriate care setting at the appropriate time.
Participate in required company training, including HIPAA privacy, Business Ethics and Compliance, and company policies and procedures.
Review and comply with company policies and procedures.
Educate patients about home health, hospice, and palliative care services.
Assist with clinical eligibility reviews for alternate services.
Participate in special projects and perform other responsibilities as assigned.