RN, Field Care Manager, Maternity, L&D, Mother Baby

Humana•Columbus, OH

7d•Hybrid

About The Position

Become a part of our caring community and help us put health first Humana Healthy Horizons in Ohio is seeking a RN Field Care Manager 2 with Maternity, L&D, Mother Baby expertise. They will assess and evaluate member's needs to achieve and/or maintain optimal wellness. The Field Care Manager will connect members/families with resources appropriate for their care and wellbeing. The RN, Field Care Manager Nurse 2 works in a CM OR CM Plus capacity based on member’s needs . Assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Responsibilities CM: Performs the full scope of care coordination activities and responsibilities for members who need care coordination and are not assigned to a Care Coordination Entity (i.e. the Ohio RISE Plan, and/or a CME, or who choose to receive their care management from the MCO). Serves as the single point of contact for care coordination. Responsibilities CM Plus: Ensures the completion of the full scope of care coordination activities and responsibilities for members who need care coordination and are assigned to a Care Coordination Entity (i.e. the Ohio RISE Plan, CPCs, and/or a CMEs). Serves as the single point of contact for care coordination. Ensures the member receives the full scope of care coordination services, including comprehensive assessment completion (inclusive of the HRA), person-centered care plan completion, ensuring no duplication with the CCEs (Ohio RISE Plan, and/or CME), and identifying and addressing ongoing needs. Provides actionable data, information, and support to assist the CCE, Ohio RISE Plan, and/or CME in meeting the member's care needs. Integrates information collected by the CCE into its Care Coordination Portal to minimize duplication. Additional Responsibilities: 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. Utilizes a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs. Performs telephonic and face to face assessments and evaluations of the member’s needs to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member. Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations. Perform clinical intervention through the development of a care plan specific to each member based on clinical judgement, changes in members’ health or psychosocial wellness, and identified triggers. Collaborates with providers and community services to promote quality and cost-effective outcomes. Coordinates delivery of needed services/supports for Physical Health, Social Determinant of Health and value-added benefits. Coordinates across the transdisciplinary care team (at a minimum the PCP) and transitions of care. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Submits incident reports. Use your skills to make an impact

Requirements

Must reside in the state of Ohio.
Registered Nurse (RN) in the state of Ohio without restrictions.
Minimum two (2) years of clinical experience (including Maternity, Labor & Delivery, Mother Baby.)
Intermediate to advanced computer skills and experience with Microsoft Word, Outlook, and Excel; excellent keyboard and web navigation skills.
Exceptional communication and interpersonal skills with the ability to quickly build rapport.
Ability to work with minimal supervision within the role and scope.
Complete education and self-development activities per Humana Healthy Horizons and departmental requirements.

Nice To Haves

Case Management Certification (CCM).
Experience working with Medicare, Medicaid or dual-eligible populations.
Field Case Management Experience.
Health Plan experience.
Knowledge of community health and social service agencies and additional community resources.
Experience with health promotion, coaching and wellness.
Bilingual (Haitian Creole, Spanish, Somali or other).

Responsibilities

Performs the full scope of care coordination activities and responsibilities for members who need care coordination and are not assigned to a Care Coordination Entity
Serves as the single point of contact for care coordination
Ensures the completion of the full scope of care coordination activities and responsibilities for members who need care coordination and are assigned to a Care Coordination Entity
Ensures the member receives the full scope of care coordination services, including comprehensive assessment completion (inclusive of the HRA), person-centered care plan completion, ensuring no duplication with the CCEs (Ohio RISE Plan, and/or CME), and identifying and addressing ongoing needs.
Provides actionable data, information, and support to assist the CCE, Ohio RISE Plan, and/or CME in meeting the member's care needs.
Integrates information collected by the CCE into its Care Coordination Portal to minimize duplication.
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.
Utilizes a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs.
Performs telephonic and face to face assessments and evaluations of the member’s needs to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member.
Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.
Perform clinical intervention through the development of a care plan specific to each member based on clinical judgement, changes in members’ health or psychosocial wellness, and identified triggers.
Collaborates with providers and community services to promote quality and cost-effective outcomes.
Coordinates delivery of needed services/supports for Physical Health, Social Determinant of Health and value-added benefits.
Coordinates across the transdisciplinary care team (at a minimum the PCP) and transitions of care.
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Submits incident reports.

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.

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