Care Manager, Telephonic Nurse

You will work as an Oklahoma-based, telephonic care manager. This care manager will assess and evaluate enrollees' needs and requirements to achieve or maintain optimal wellness. The care manager will guide enrollees/families towards and facilitate interaction with appropriate resources for their care and wellbeing. The Care Manager, Telephonic Nurse 2 work assignments are varied but will focus on those enrollees with a primary physical health diagnosis. We are looking for interpretation and independent determination of appropriate actions and may require home or facility-based visits to enhance enrollee engagement and services. You will work in collaboration with the interdisciplinary care management team. This team includes community health workers, housing support specialists, SDOH coordinators, and care management support assistants. We design this team-based approach to ensure enrollees receive holistic person-centered care management. The Care Manager, Telephonic Nurse will utilize clinical expertise and experience to determine when face-to-face enrollee support is required. You will engage the appropriate members of the care management team and/or coordinate in-person meetings between the care manager and the enrollee.

The Care Manager, Telephonic Physical Health Nurse, Responsibilities include

• Employ a variety of strategies, approaches, and techniques to manage an Enrollee's behavioral, physical, environmental, and psycho-social health needs.
• Ensure Enrollees are progressing toward desired outcomes by continuously monitoring their assessments and evaluations.
• Identifies and resolves barriers that hinder effective care and ensures through continuous monitoring of assessments and evaluations that the Enrollee is progressing toward desired outcomes.
• Create Enrollee care plans, and understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Performs telephonic and face-to-face assessments and evaluations of the member's needs and requirements. These assessments aim to achieve and/or maintain an optimal wellness state. By guiding members/families toward the appropriate resources, the goal is to ensure the care and overall wellbeing of the member.
• Ensure member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.
• Create member care plans. Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Collaborate with providers and community services to promote quality and cost-effective outcomes.
• Follow established guidelines/procedures.
• Possible travel to Humana Oklahoma office for meetings and training

Required Qualifications

• Must reside in Oklahoma.
• Active Registered Nurse (RN) license, Licensed Professional Counselor (LPC), or Licensed Clinical Social Worker (LCSW)
• Minimum 1-year clinical experience.
• 2 or more years of care management.
• Experience working with Medicaid and/or Medicare Enrollees to coordinate services, care needs or benefits.
• Knowledge of community health and social service agencies and additional community resources.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint.

Preferred Qualifications

• Case Management Certification
• Bilingual Spanish Speaking

Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.