The Field Care Manager Nurse 2 assesses and evaluates member's 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 Field Care Manager Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Overview

The Pediatric Care Manager (Care Manager, Nurse 2) performs telephonic and face-to-face assessments and evaluations of Moderate to High acuity member's needs and requirements to achieve and/or maintain optimal wellness by guiding members/families toward and facilitate interaction with resources appropriate for the care and well-being of pediatric members and their families/caregivers, including children with acute, chronic, complex, and special healthcare needs. The CM RN utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical and behavioral healthcare through care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. The Care Manager's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Position Responsibilities

• Coordinates care for children with chronic conditions, complex medical needs, developmental disabilities, behavioral health conditions, and medically fragile conditions.
• Responsible for telephonic and/or face to face assessment, planning, implementing and coordinating care management activities for pediatric members, ensuring developmental, behavioral, medical, and psychosocial needs are addressed through collaboration with families, caregivers, providers, and community resources.
• Identifies and resolves barriers that hinder effective care. Ensure patients are progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations.
• Responsible for health risk assessments along the continuum of care for members
• Using a holistic approach, consults with manager, medical directors, and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives.
• Candidate will assess the members, create individualized care plans, and attend interdisciplinary care team meetings.
• Works collaboratively with the members' interdisciplinary care team.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Collaboration with internal and external providers or departments to meet the members' needs
• Meet requirements for contractual and regulatory compliance
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

Required Qualifications

• Must reside in Illinois or a border state within a commutable distance of IL.
• Minimum Associates nursing degree required
• 3+ years of experience, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
• 2+ years of experience of care management
• At least one year of acute care clinical experience is required. This experience can be in a hospital, emergency department, home health, rehabilitation, ambulatory care, skilled nursing, behavioral health, case management, disease management, utilization management, or clinical triage setting.
• Knowledge of community health and social service agencies and additional community resources.
• Ability to use a variety of electronic information applications/software programs including electronic medical records
• Excellent keyboard and web navigation skills
• Willing and able to travel up to 25% of their time

Preferred Qualifications

• Bachelor's of Science in Nursing (BSN)
• 3+ years of in-home assessment and care coordination experience
• Experience with health promotion, coaching and wellness
• Previous managed care experience
• Bilingual preferred (Spanish, Arabic, Vietnamese or other)
• Certification in Case Management
• Motivational Interviewing Certification and/or knowledge
• Familiarity with Early Intervention (EI), Individualized Education Programs (IEPs), and community-based pediatric support programs.
• Experience with pediatric behavioral health, autism spectrum disorders, ADHD, developmental disabilities, or medically complex children.
• Knowledge of pediatric developmental milestones and age-appropriate care management interventions.

Additional Information

• Workstyle: This is a remote position that requires travel.
• Travel: Up to 25% field-based interactions meeting with members and/or their families, community partners and other care teams. May need to attend occasional onsite meetings in Humana's Illinois locations.
• Typical Workdays and Hours: Monday - Friday 8:00 AM - 5:00 PM CST. May need to be provide flexibility with work schedule based on business needs.
• Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

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.