Care Manager, Telephonic Nurse

Humana

3d•$71,100 - $97,800•Remote

About The Position

As a remote Telephonic Care Manager, you will provide comprehensive, holistic case management for beneficiaries with complex medical needs throughout the continuum of care. You will use specialized interventions and appropriate care sites and levels of care to help prevent or reduce hospital readmissions, promote appropriate use of alternative funding sources, improve care coordination, and reduce fragmentation of clinical services. You will serve as the beneficiary’s point of contact for activities across the clinical spectrum. You will coordinate with Care Management programs, Military Treatment Facility (MTF) Utilization Management and Case Management staff, and providers to help ensure an integrated care plan addresses all beneficiary needs and conditions. The role reports to a Manager of Care Management. This is a remote, 40-hour-per-week position with a Monday–Friday schedule. The workday is an eight-hour shift between 8:00 a.m. and 6:00 p.m. Eastern Time, with required training during the first four weeks from 8:00 a.m. to 5:00 p.m. Eastern Time. Occasional travel to Humana offices for training or meetings may be required. Home workers must have internet service with at least 25 Mbps download and 10 Mbps upload speeds and a dedicated workspace suitable for protecting member PHI and HIPAA information.

Requirements

U.S. citizenship is required under the Department of Defense contract.
Successfully receive interim approval for government security clearance through NBIS (National Background Investigation Services).
Candidates must not currently live in Puerto Rico, where HGB is not authorized to perform work under its government contract.
Active RN license in the state of employment.
Ability to obtain CCM certification within one year of hire.
Two years of case management experience.
Three years of clinical RN or managed care RN experience.
Ability to work Monday through Friday, either 8:00 a.m.–5:00 p.m. ET or 9:00 a.m.–6:00 p.m. ET.
Ability to work an eight-hour shift between 8:00 a.m. and 6:00 p.m. ET.
For home work, internet service must provide at least 25 Mbps download and 10 Mbps upload speeds.
Maintain a dedicated workspace without ongoing interruptions to protect member PHI and HIPAA information.

Nice To Haves

Bachelor’s degree in nursing.
TRICARE experience.
Experience with MCG.
Current CCM certification.

Responsibilities

Provide comprehensive, holistic case management for complex medical needs throughout the continuum of care.
Use specialized case management interventions and appropriate care sites and levels of care to prevent or reduce hospital readmissions.
Promote appropriate utilization of alternative sources of available funding.
Enhance coordination of care and reduce fragmentation of clinical services.
Serve as the beneficiary’s point of contact for activities within the clinical spectrum.
Coordinate with Care Management programs, MTF Utilization Management and Case Management staff, and providers to support an integrated care plan addressing beneficiary needs and conditions.