Care Manager, Telephonic Nurse

As a remote Telephonic Care Manager you will report to a Manager of Care Management. You will be providing a comprehensive, holistic approach for the complex medical Case Management (CM) program throughout the continuum of care. You will provide case management specialized interventions by leveraging the most appropriate care sites and levels of care to prevent or decrease hospital readmissions, promoting appropriate utilization of alternative sources of available funding, enhancing coordination of care, and reducing fragmentation of clinical services.

You will serve as the point of contact for the beneficiary for all activities within the clinical spectrum. You will coordinate within the Care Management programs, Military Treatment Facility (MTF) Utilization Management/Case Management/CM staff, and providers to ensure there is a fully integrated care plan addressing all beneficiary needs and conditions.

Required Qualifications

• Our Department of Defense Contract requires U.S. citizenship for this position.
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
• Active RN license in state of employment
• Ability to obtain CCM certification within 1 year of hire
• 2 years case management experience
• 3 years clinical RN or managed care RN experience
• Must be able to work M - F, 8 a.m. - 5 p.m. ET or 9 a.m. - 6 p.m. ET

Preferred Qualifications

• Bachelor's degree in nursing
• TRICARE experience
• Experience with MCG
• Current CCM

Additional Information

Work Style: Remote Work Schedule: Monday – Friday; must be able to work an 8-hour shift between the hours of 8:00 a.m. – 6 p.m. ET (Eastern Time)

Training/Training Hours: Mandatory for the first 4 weeks between the hours 8:00 a.m. – 5:00 p.m. ET (Eastern Time)

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.