RN Field Care Manager - Medicaid HCBS/LTSS

Humana • Chittenden, VT

3d • $71,100 - $97,800 • Remote

About The Position

The Field Care Manager Nurse 2 assesses members’ needs and helps members and their families access appropriate resources to achieve or maintain optimal health and well-being. The Field Care Manager Nurse 2 uses a range of strategies to address members’ physical, environmental, and psychosocial health needs. This is a Field-based position requires 75%–90% travel within an assigned area of Wayne and/or Macomb Counties to conduct in-home visits with Medicare and Medicaid members within a 30- to 40-mile radius.

Requirements

• Must reside in the state of Michigan (Wayne or Macomb Counties).
• Active Michigan license as a Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN), including Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS), with no disciplinary actions.
• Experience with Home and Community-Based Services (HCBS) and waiver programs.
• 2+ years of experience in healthcare and/or case management.
• Experience conducting Long-Term Services and Supports (LTSS) assessments, working with Medicaid regulations, and applying person-centered planning principles.
• Experience collaborating with interdisciplinary teams, providers, members, and caregivers to complete comprehensive assessments and recommend appropriate services.
• Demonstrated ability to maintain timely, accurate, and compliant documentation in accordance with organizational, state, and federal requirements.
• Knowledge of community health, social service agencies, and community resources.
• Ability to use electronic information systems and software programs, including electronic medical records (EMRs).
• Excellent keyboarding and web navigation skills.
• Intermediate to advanced computer skills, including experience with Microsoft Word, Outlook, and Excel.

Nice To Haves

• Bachelor of Science in Nursing (BSN)
• Experience completing InterRAI Integrated Health Care (IHC) Assessments, including assessment methodology, care planning, and identification of clinical, functional, cognitive, and psychosocial needs
• Experience conducting and documenting Nursing Facility Level of Care Determinations (NFLOCDs) in accordance with state Medicaid, Long-Term Services and Supports (LTSS), and regulatory requirements
• Experience in health promotion, coaching, and wellness
• Previous experience in managed care

Responsibilities

• Manages a caseload and completes member assessments in home, community-based, and telephonic settings.
• Provides clinical support and guidance, particularly for members with complex medical needs.
• Develops and coordinates care plans to ensure members receive appropriate services to manage their health effectively.
• Addresses barriers to healthcare and advocates for optimal member outcomes.
• Reviews, evaluates, and completes medical complexity attestations and clinical oversight activities.
• Assesses care needs to ensure members receive services in the least restrictive setting and achieve or maintain optimal well-being.
• Develops and updates the Individual Care Plan with applicable care team members, including informal caregivers, coaches, and primary care providers.
• Uses an interdisciplinary approach to help members and caregivers access social, housing, educational, and other services needed, regardless of funding source.
• Serves as the primary contact for the Interdisciplinary Care Team (ICT), coordinating with the member, ICT participants, and external resources to ensure the members’ needs are met.
• Conducts comprehensive InterRAI Integrated Health Care (IHC) assessments and Nursing Facility Level of Care Determinations (NFLOCDs) to evaluate members’ clinical, functional, cognitive, behavioral, and psychosocial needs; support accurate eligibility decisions and person-centered care planning; and ensure compliance with state Medicaid, LTSS, HCBS waiver, and regulatory requirements.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level