Care Manager, Telephonic Nurse

CenterWell

3d • Remote

About The Position

Become a part of our caring community and help us put health first Shift/availability details: Full time 40 hours a week scheduled for 8 hour shifts, 5 days a week. The schedule is Monday-Friday from 5pm-1:30am ET. Required to work every other weekend on Saturday & Sunday from 5pm-1:30am ET. When working weekends, it will allow for off days during the week. Required to work every other holiday. This is a work-from-home telephonic Registered Nurse position. As a Care Manager, Telephonic Nurse, you will report directly to the Manager, Care Management. You will help to ensure optimal continuity of care for patients transitioning into and out of our services. You will be responsible for being highly knowledgeable regarding post-acute levels of care, and an expert regarding CenterWell Home Health services including home health, hospice, and palliative care. You will communicate with the CenterWell Home Health clinical team and help facilitate patient follow-up for patients in need of (additional) services. Essential Functions: Be a CenterWell Home Health representative in supporting patients who have been discharged from service or for those who may need post-acute services. Navigate healthcare options; care services post-acute offerings, Medicare coverage, billing issues, and accessing healthcare resources. Use a variety of tools and methods to quickly provide patient options and education including but not limited to sites of service, specialty offerings, post-acute care, and other related questions. Handle a variety of customer issues including location lookup, directions, and complaints. Make clinical level of care determination based on discussion, medical records, and any other important clinical data. Match these needs to a service site location or, if not available, look up and provide alternative services. Be a customer advocate throughout the referral process to ensure timely response and to maximize referral to admission conversion rate. Follow-up and track referral and admission outcomes. Maintain awareness and orientation to department performance objectives, meets standards, and assures patient satisfaction goals are met. Assist in the admissions process by acting as an ambassador for patients who meet the admissions requirements. Focus on placing the right patient to the right care setting at the right time Adhere to and participates in Company's mandatory training which includes but is not limited to HIPAA privacy program/practices, Business Ethics and Compliance programs/practices, and Company policies and procedures. Review and adhere to all Company policies and procedures. Provide education regarding Home Health, Hospice, and Palliative Care Services. Help with clinical eligibility review for alternate services Participate in special projects and perform other responsibilities as assigned. Use your skills to make an impact

Requirements

• Associates Degree required. BSN preferred.
• We require a compact state RN license. Business needs may require additional state licensures be obtained.
• At least 3 years post-acute experience.
• Home Care or hospice experience preferred.
• Nursing background working across multiple areas of post-acute care.
• Nursing experience in post-acute care.
• Current CPR certification.
• Knowledge of home health, hospice, and palliative care services.
• Ability to learn and master information related to locations and services of clients.
• Excellent analytical and problem-solving skills.
• Excellent verbal and interpersonal skills.
• Communicate effectively with empathy over the phone.
• Must read, write and speak fluent English.
• 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. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Home Care or hospice experience preferred.

Responsibilities

• Be a CenterWell Home Health representative in supporting patients who have been discharged from service or for those who may need post-acute services.
• Navigate healthcare options; care services post-acute offerings, Medicare coverage, billing issues, and accessing healthcare resources.
• Use a variety of tools and methods to quickly provide patient options and education including but not limited to sites of service, specialty offerings, post-acute care, and other related questions.
• Handle a variety of customer issues including location lookup, directions, and complaints.
• Make clinical level of care determination based on discussion, medical records, and any other important clinical data.
• Match these needs to a service site location or, if not available, look up and provide alternative services.
• Be a customer advocate throughout the referral process to ensure timely response and to maximize referral to admission conversion rate.
• Follow-up and track referral and admission outcomes.
• Maintain awareness and orientation to department performance objectives, meets standards, and assures patient satisfaction goals are met.
• Assist in the admissions process by acting as an ambassador for patients who meet the admissions requirements.
• Focus on placing the right patient to the right care setting at the right time
• Adhere to and participates in Company's mandatory training which includes but is not limited to HIPAA privacy program/practices, Business Ethics and Compliance programs/practices, and Company policies and procedures.
• Review and adhere to all Company policies and procedures.
• Provide education regarding Home Health, Hospice, and Palliative Care Services.
• Help with clinical eligibility review for alternate services
• Participate in special projects and perform other responsibilities as assigned.

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree