Field Care Manager Nurse
About The Position
The Stars Improvement, Clinical Professional 2 is responsible for the development, implementation, and management oversight of the company's Medicare/Medicaid Stars Program. This role involves varied work assignments that frequently require interpretation and independent determination of appropriate courses of action. The Stars Improvement Clinical Professional (RN) collaborates with market leadership and the quality improvement team to develop and implement programs designed to increase patient outcomes. Work is performed within the associate's assigned center locations and in collaboration with existing Quality Improvement Coordinators and Professionals, and in close partnership with market and center teams. The Stars Improvement, Clinical Professional (RN) represents the scope of provider relationships across several areas including quality/clinical management and population health, HEDIS and Stars performance, operational improvements, financial performance and incentive programs, data sharing and connectivity, documentation and coding, and additional areas related to provider performance, member experience, market growth, provider experience, and operational excellence.
Requirements
- Registered Nurse with 2 years of experience in home case/care management.
- Experience working with the adult population.
- Knowledge of community health and social service agencies and additional community resources.
- Ability to travel to member's residence within 30 to 40 miles.
- Exceptional communication and interpersonal skills with the ability to quickly build rapport.
- Ability to work with minimal supervision within the role and scope.
- Ability to use a variety of electronic information applications/software programs including electronic medical records.
- Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel.
- Excellent keyboard and web navigation skills.
- Ability to work a full-time (40 hours minimum) flexible work schedule.
- Must have a valid state driver's license.
- Must maintain personal vehicle liability insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
- Must have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you work.
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed for optimal performance from Humana At Home systems is 5Mx1M.
- This role is considered patient facing and is part of Humana At Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
- Valid driver's license, car insurance, and access to an automobile.
- Associates working in the State of Florida will need ACHA Level II Background clearance.
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Nice To Haves
- BSN
- 3-5 years of in home assessment and care coordination experience
- Experience with health promotion, coaching and wellness
- Previous managed care experience
- Bilingual — English, Spanish
- Certification in Case Management
- Motivational Interviewing Certification and/or knowledge
Responsibilities
- Development, implementation, and management oversight of the company's Medicare/Medicaid Stars Program.
- Collaborate with market leadership and quality improvement team to develop and implement programs designed to increase patient outcomes.
- Perform work within assigned center locations in collaboration with existing Quality Improvement Coordinators and Professionals.
- Partner closely with market and center teams.
- Represent the scope of provider relationships across quality/clinical management and population health.
- Manage HEDIS and Stars performance.
- Drive operational improvements.
- Oversee financial performance and incentive programs.
- Facilitate data sharing and connectivity.
- Ensure proper documentation and coding.
- Address additional areas related to provider performance, member experience, market growth, provider experience, and operational excellence.
Benefits
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- Short-term disability
- Long-term disability
- Life insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
