Field Care Manager Nurse

CenterWell • Louisville, KY

1d • Remote

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.
• Valid state driver's license.
• Personal vehicle liability insurance in accordance with the residing state's 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.
• A separate room with a locked door that can be used as a home office to ensure continuous privacy while you work.
• Accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed). Recommended speed for optimal performance from Humana At Home systems is 5Mx1M.
• Must be screened for Tuberculosis (TB) as part of Humana At Home's Tuberculosis (TB) screening program.
• Valid driver's license, car insurance, and access to an automobile.
• For associates working in the State of Florida, ACHA Level II Background clearance is required.
• 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 assignments that require interpretation and independent determination of appropriate courses of action.
• Represent provider relationships across quality/clinical management, population health, HEDIS and Stars performance, operational improvements, financial performance and incentive programs, data sharing and connectivity, documentation and coding, 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed