Responsibilities

• Telephonically support Medicare members with transitional care needs and complex chronic conditions.
• Assess members' physical, environmental, behavioral, and psychosocial health needs.
• Continuously assessing member progress and adjust care interventions to support optimal health outcomes.
• Develop, implement, and monitor individualized care plans as appropriate.
• Connect members and families with appropriate healthcare, community, and social service resources.
• Coordinate care and collaborate with interdisciplinary teams to address member needs and improve outcomes.
• Employ a variety of clinical strategies and interventions to manage member health concerns.
• Evaluate member risk factors and implement interventions designed to prevent avoidable hospitalizations and emergency department utilization.
• Identify and address barriers to care, including social, financial, environmental, and functional challenges.
• Exercise sound clinical judgment and independent decision-making in a fast-paced care management environment.

Required Qualifications

• An active, unrestricted Registered Nurse (RN) license in state of residence with active Compact (Multistate) licensure with no disciplinary action.
• Three (3) or more years of clinical acute care experience, including case management, discharge planning, and patient education for adult populations.
• Demonstrated clinical expertise managing chronic conditions through assessment, care coordination, clinical intervention, and individualized care planning.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Proficiency with Microsoft Office (Word, Excel, Outlook) and the ability to efficiently navigate multiple systems and applications simultaneously, including dual-monitor environments.
• Ability to manage multiple priorities in a fast-paced, telephonic care management environment.
• Advanced verbal and written communication skills, including the ability to effectively engage members through telephonic and virtual interactions.

Preferred Qualifications

• BSN or MSN degree.
• Managed care experience.
• Certified Case Manager (CCM).
• Bilingual (English and Spanish); with the ability to read, write, and speak in both languages with no limitations or assistance.

Additional Information

• Training Schedule: The first 4 weeks of training work hours will be from 8:30AM to 5:00PM Eastern Time (ET). Please note that no time off is permitted during the first month of training, as full attendance is required to successfully complete the onboarding and training program.
• Work Schedule: After training, Associates residing in the Eastern Time Zone (ET) will work from 9:00 AM to 5:30 PM ET. Associates residing in the Central Time Zone (CT) will work from 10:00 AM to 6:30 PM ET.

Work Environment

• This is a remote, work-at-home position requiring a dedicated home office workspace.
• Care Managers spend the majority of their day engaging members telephonically through an auto-dialer environment.
• The role requires the ability to build rapport quickly while navigating multiple technology platforms simultaneously.
• Due to business and regulatory requirements, schedules are highly structured with limited day-to-day flexibility.
• Care Managers are expected to meet established quality, productivity, and member outcome goals while demonstrating strong communication and relationship-building skills.

What Makes You Successful in This Role

• You build rapport quickly and create meaningful connections with members in a telephonic environment.
• You are comfortable managing multiple priorities while navigating several technology platforms simultaneously.
• You use critical thinking and sound clinical judgment to address complex member needs.
• You adapt quickly to changing priorities, workflows, and business requirements.
• You thrive in a structured, fast-paced environment while maintaining a high level of quality and member focus.

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.