Care Manager Telephonic Registered Nurse RN 2

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Job Information

Humana

Care Manager, Telephonic Registered Nurse, (RN) 2

in

Troy

Michigan

Description

The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' 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 wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Case Manager will be a member of the Case Management Team, providing a comprehensive, holistic approach for case management throughout the continuum of care. The case manager will offer guidance, support, and coordination of the beneficiary's care as directed by the beneficiary, the provider(s) or other members of the healthcare team and within the scope of the case manager's licensure. The case manager will assess, plan, coordinate, implement, monitor, and evaluate the medical services required to meet the complex health needs of TRICARE beneficiaries, to maximize each beneficiary's capacity for self-care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care. The case manager will collect and document data to facilitate measurement of case management involvement. The case manager, will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical and behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in addition to MTF UM / CM staff, physicians and providers as necessary; organize, arrange and coordinate services necessary to address the beneficiary's condition. In their role, the Case Manager will collaborate with other care management programs until the beneficiary's needs are met and case closure or graduation is achieved. Performs all duties within the scope of his/her licensure.

We have multiple Case Management positions available, with an anticipated start date on 11 April 2022.

Our Department of Defense Contract requires U.S. citizenship for this position.

KEY ACCOUNTABILITIES

30

% 1. Utilize applicable sources of information to identify, assess, and enroll patients requiring case management

35%

2. Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the Case Management purview across the continuum of care. Develop a cost effective treatment plan that is acceptable to both the beneficiary (patient) and other members of the care team utilizing both evidence based medical information, DoD and community resources (SDOH). Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care. Maintain beneficiary's privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.

25%

3 .

Coordinate and collaborate with other members of the care management team or external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the case management team.

10%

4. Support the Care Coordinators with the coordination of care for beneficiaries not under case management as needed.

Required Qualifications

Licensed Registered Nurse (RN) in resident state with no disciplinary action

Minimum 3 years of clinical acute care experience in a hospital, home health, skilled, or, rehabilitative

Certified Case Manager with 2 years case management case management, discharge planning and patient education for adult acute care

Intermediate working knowledge using MS Office applications, multiple systems and platforms, and have a technical aptitude to troubleshoot and resolve common issues.

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Additional Requirements/Adherence

Workstyle:

Remote work at home

Location:

United States (excluding Alaska, Hawaii)

Hours:

40 hour work week 7:30AM - 6:00 PM local time, occasional over-time to support business needs.

Travel:

Anticipate training at no more than 10% annually for all hands functions.

Work at home requirements:

Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work

Must have accessibility to hardwired high speed internet with minimum speeds of 25Mx10M for a home office (Wireless and Satellite are prohibited)

Preferred Qualifications

Bachelor's

Knowledge of MCG, Milliman, or, Interqual, (MCG preferred)

Managed care experience

Additional Information

Covid Compliance Policy

For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination, including booster or commit to testing protocols

*OR  *

Provide proof of applicable exemption including any required supporting documentation

Medical, religious, state and remote-only work exemptions are available.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed)

inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com