Humana-posted 2 days ago
Full-time • Mid Level
Remote • Roanoke, VA
5,001-10,000 employees

Become a part of our caring community and help us put health first Humana Healthy Horizons in Virginia is seeking a RN, Field Care Manager Nurse 2 (Maternal-Health) who will assess and evaluate high acuity member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and well-being of members who are pregnant and postpartum. The RN, Field Care Manager Nurse 2 (Maternal-Health) work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Responsible for health risk assessments along the continuum of care for members. Assesses members, creates individualized care plans, and attends interdisciplinary care team meetings. Employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures members are progressing towards desired outcomes by continuously monitoring their care through assessments and/or evaluations. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous. situations, and requires minimal direction and receives guidance where needed. Collaborates with internal and external providers or departments to meet the member’s needs. Meets requirements for contractual and regulatory compliance. Follows established guidelines/procedures. Use your skills to make an impact

  • Assess and evaluate high acuity member's needs and requirements to achieve and/or maintain optimal wellness state
  • Guide members/families toward and facilitate interaction with resources appropriate for the care and well-being of members who are pregnant and postpartum
  • Responsible for health risk assessments along the continuum of care for members
  • Assess members, creates individualized care plans, and attends interdisciplinary care team meetings
  • Employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues
  • Identifies and resolves barriers that hinder effective care
  • Ensures members are progressing towards desired outcomes by continuously monitoring their care through assessments and/or evaluations
  • Collaborates with internal and external providers or departments to meet the member’s needs
  • Meets requirements for contractual and regulatory compliance
  • Follows established guidelines/procedures
  • Must reside in the central to northern Roanoke/Alleghany Region in the Commonwealth of Virginia in the counties/independent cities of Giles, Montgomery, Roanoke, Salem, Bedford, Craig, Botetourt, Covington, Alleghany, Rockbridge, Buena Vista, Lexington, Bath and Highland.
  • 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.
  • Minimum one (1) year of acute care experience working in obstetrics, women’s care, labor and delivery, mother, baby, NICU and/or clinical triage.
  • Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel.
  • Knowledge of community health and social service agencies and additional community resources.
  • Exceptional oral and written 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.
  • Excellent keyboard and web navigation skills.
  • Ability to travel to region-based facilities and homes for face-to-face assessments.
  • This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
  • This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  • To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  • Bachelor's of Science in Nursing (BSN).
  • 3-5 years of in-home assessment and care coordination experience.
  • Lactation experience, preferably as a certified lactation consultant.
  • Experience with health promotion, coaching and wellness.
  • Previous managed care experience.
  • Certification in Case Management (CCM).
  • Motivational Interviewing Certification and/or knowledge.
  • Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations or assistance.
  • 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.
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