RN, Field Care Manager (Adults and Pediatrics)

Humana

28d • Remote

About The Position

Become a part of our caring community and help us put health first Humana Healthy Horizons in Virginia is looking for RN, Field Care Managers (Field Care Manager Nurse 2) who performs primarily face to face and telephonic assessments to adult and pediatric members. The RN, Field Care Manager (Field Care Manager Nurse 2) will evaluate member's needs to achieve and/or maintain optimal wellness. This position employs a variety of strategies, approaches, and techniques to manage a member's health issues and identifies and resolves barriers that hinder effective care. They ensure members are progressing towards desired outcomes by continuously monitoring care through use of assessment, data, conversations with member, and active care planning. The RN, Field Care Manager (Field Care Manager, Nurse 2) understands professional concepts, regulations, strategies, and operating standards. They make decisions regarding work approach/priorities and follows direction. Responsible for managing a case load and completing assessments with members in their home or community-based setting, as well as telephonically. Provides clinical support and guidance, particularly for members with medical complexity. Develops and coordinates care plans ensuring that patients receive appropriate services to manage their health needs effectively. Addresses barriers to health care and advocating for optimal member outcomes. Reviews, assesses, and completes medical complexity attestations and clinical oversights. Ensures members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs. Develops and modifies Individual Care Plan and involve applicable members of the care team in care planning (Informal caregiver, coach, PCP, etc.). Focuses on supporting members and/or caregivers utilizing an interdisciplinary approach in accessing social, housing, educational and other services, regardless of funding sources to meet their needs. Collaborates with Community Health Workers (CHW), Housing Specialist and other internal and external agencies for HRSN needs. Primary point of contact for the ICT and shall be responsible for coordinating with the member, ICT participants, and outside resources to ensure the member’s needs are met. Use your skills to make an impact

Requirements

• Must reside in the Commonwealth of Northern Virginia
• Active Registered Nurse (RN) license in the Commonwealth of Virginia without disciplinary action.
• Two (2) years of prior experience in health care and/or case management.
• One (1) year of experience working directly with individuals who meet the Cardinal Care Priority Population criteria (adults, pediatrics populations at risk for chronic medical conditions and high social needs).
• Strong advocate and respect for members at all levels of care.
• Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook.
• Ability to use a variety of electronic information applications/software programs including electronic medical records.
• Exceptional oral and written communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.
• Ability to work with minimal supervision within the role and scope.
• Ability to work a full-time schedule.

Nice To Haves

• Prior experience with Medicare, Medicaid and dual eligible populations.
• Bachelor's Degree Nursing (BSN).
• Case Management Certification (CCM).
• Experience with health promotion, coaching and wellness.
• Knowledge of community health and social service agencies and additional community resources.
• Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance.

Responsibilities

• Managing a case load and completing assessments with members in their home or community-based setting, as well as telephonically.
• Provides clinical support and guidance, particularly for members with medical complexity.
• Develops and coordinates care plans ensuring that patients receive appropriate services to manage their health needs effectively.
• Addresses barriers to health care and advocating for optimal member outcomes.
• Reviews, assesses, and completes medical complexity attestations and clinical oversights.
• Ensures members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs.
• Develops and modifies Individual Care Plan and involve applicable members of the care team in care planning (Informal caregiver, coach, PCP, etc.).
• Focuses on supporting members and/or caregivers utilizing an interdisciplinary approach in accessing social, housing, educational and other services, regardless of funding sources to meet their needs.
• Collaborates with Community Health Workers (CHW), Housing Specialist and other internal and external agencies for HRSN needs.
• Primary point of contact for the ICT and shall be responsible for coordinating with the member, ICT participants, and outside resources to ensure the member’s needs are met.

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: Mid Level