RN Care Manager, Telephonic

Humana • Milwaukee, WI

1d • Hybrid

About The Position

The Care Management Telephonic Nurse is a licensed registered nurse who works within an interdisciplinary team to support Independent Care members with complex, episodic medical, behavioral health, and social needs. This role reports to the Manager of Care Management Support and involves collaboration with health care providers, behavioral health professionals, and social service agencies to promote high quality, efficient, and cost effective delivery of health and social services through assessment, care planning, coordination, and ongoing monitoring.

Requirements

• Bachelor's degree
• Minimum 2 years of clinical acute care experience
• Licensed Registered Nurse (RN) in WI with no disciplinary action

Nice To Haves

• Experience with case management, discharge planning and patient education for adult acute care
• Managed care experience
• Reside within the State of WI

Responsibilities

• Assist Care Coordinators and Care Managers in the oversight, development, and prioritization of member care plans addressing complex medical, behavioral health, and social needs
• Monitor member status and direct members to appropriate specialty services, community resources, and alternative treatment settings
• Participate in coordinating member discharge needs in collaboration with facility discharge planners, Care Coordinators, Care Managers, and behavioral health personnel, and assists with medical transitions of care
• Coordinate services, communicate clinical information, and interface with health care providers regarding the management of current medical, behavioral health, and social needs
• Support the high risk and complex case management team with completing comprehensive assessments and managing members
• Educate on chronic conditions and preventive health measures
• Interpret and administer benefits following regulatory requirements, contractual obligations, and medical management guidelines
• Problem‑solve with staff, members, and providers to identify appropriate alternatives or solutions to care needs
• Complete accurate, timely, and compliant documentation following iCare policies, workflows, and documentation standards
• Participate in interdisciplinary team meetings as a member or facilitator
• Be a clinical resource to iCare staff and assist with training and mentoring of employees
• Occasionally assist in developing and delivering presentations to external agencies or organizations
• Support program development, policy and procedure enhancements, and provide input to Quality Improvement and Quality Assurance initiatives
• Perform other duties as assigned, including mentoring and special projects

Benefits

• medical benefits
• dental benefits
• 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 disability
• long-term disability
• life insurance
• bonus incentive plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees