Care Manager, Telephonic Nurse
About The Position
This is a full-time, work-from-home telephonic Registered Nurse position working 40 hours per week over four 10-hour shifts. The alternating schedule is Monday, Thursday, Friday, and Saturday from 10:30 a.m. to 9 p.m. EST in Week 1, and Sunday, Tuesday, Thursday, and Friday from 10:30 a.m. to 9 p.m. EST in Week 2. The role requires a rotating holiday schedule. Training may take place on days or times outside the advertised shift, and shifts may change based on patient-care needs and business demands. Reporting to the Manager, Care Management, the Care Manager supports continuity of care for patients transitioning into or out of 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 CenterWell Home Health's clinical team and helps arrange follow-up for patients who need additional services. The Care Manager educates patients about healthcare options, post-acute services, Medicare coverage, billing issues, and healthcare resources. The nurse reviews clinical information to determine an appropriate level of care, connects patients with suitable service locations or alternatives, and advocates for patients through the referral process. The role also supports admissions, tracks referral and admission outcomes, and works toward timely responses, patient satisfaction, and referral-to-admission goals. This remote role may require occasional travel to Humana offices for training or meetings. Work-from-home employees must provide internet service with at least 25 Mbps download and 10 Mbps upload speeds, and work from a dedicated space without ongoing interruptions to protect member PHI and HIPAA information.
Requirements
- Associate degree required.
- Compact state RN license required; business needs may require obtaining additional state licenses.
- 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 ability.
- Excellent verbal and interpersonal skills.
- Ability to communicate empathetically over the phone.
- For work from home: self-provided internet service must provide at least 25 Mbps download and 10 Mbps upload speeds.
- For work from home: ability to work from a dedicated space without ongoing interruptions to protect member PHI and HIPAA information.
Nice To Haves
- Bachelor of Science in Nursing (BSN).
- Home health or hospice experience.
Responsibilities
- Support patients discharged from service or those who may need post-acute services, and help them navigate care options, Medicare coverage, billing issues, and healthcare resources.
- Use available tools and methods to provide patient options and education about sites of service, specialty offerings, post-acute care, and related questions.
- Handle customer issues including location lookup, directions, and complaints.
- Determine clinical level of care based on patient discussions, medical records, and other relevant clinical data.
- Match patient needs to an appropriate service location or identify and provide alternative services when an appropriate location is unavailable.
- Advocate for patients throughout the referral process to encourage timely responses and maximize referral-to-admission conversion; follow up and track referral and admission outcomes.
- Maintain awareness of department performance objectives, meet standards, and support patient satisfaction goals.
- Assist with admissions by acting as an ambassador for patients who meet admission requirements.
- Help place the right patient in the right care setting at the right time.
- Complete and participate in mandatory company training, including HIPAA privacy and Business Ethics and Compliance programs, and follow company policies and procedures.
- Educate patients about 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
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Other wellness and benefit opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
