Care Manager, Telephonic Nurse

CenterWell

1d • Remote

About The Position

Become a part of our caring community Shift/Availability Requirements: Full time 40 hours a week scheduled for 8 hour shifts, 5 days a week. The schedule is Monday-Friday from 1:30am-10am ET. Required to work every other weekend on Saturday & Sunday from 1:30am-10am ET. When working weekends, it will allow for off days during the week. Required to work a rotating holiday schedule. 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 to be 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.

Requirements

• Associate's degree required.
• We require a compact state RN license.
• Business needs may require additional state licensures be obtained.
• At least 3 years post-acute experience.
• 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.
• 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• BSN preferred.
• Home health 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 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: Manager
• Education Level: Associate degree