The Field Care Manager Nurse 2 assesses members’ needs and helps members and their families access appropriate resources to achieve or maintain optimal health and well-being.
The Field Care Manager Nurse 2 uses a range of strategies to address members’ physical, environmental, and psychosocial health needs.
- Must reside in Michigan and be able to drive to Wayne and/or Macomb Counties.
- This is a Field-based position requires 75%–90% travel within an assigned area of Wayne and/or Macomb Counties to conduct in-home visits with Medicare and Medicaid members within a 30- to 40-mile radius.
Position Responsibilities
- The RN Field Care Manager manages a caseload and completes member assessments in home, community-based, and telephonic settings.
- Provides clinical support and guidance, particularly for members with complex medical needs. Develops and coordinates care plans to ensure members receive appropriate services to manage their health effectively.
- Addresses barriers to healthcare and advocates for optimal member outcomes.
- Reviews, evaluates, and completes medical complexity attestations and clinical oversight activities.
- Assesses care needs to ensure members receive services in the least restrictive setting and achieve or maintain optimal well-being.
- Develops and updates the Individual Care Plan with applicable care team members, including informal caregivers, coaches, and primary care providers.
- Uses an interdisciplinary approach to help members and caregivers access social, housing, educational, and other services needed, regardless of funding source.
- Serves as the primary contact for the Interdisciplinary Care Team (ICT), coordinating with the member, ICT participants, and external resources to ensure the members’ needs are met.
- Conducts comprehensive InterRAI Integrated Health Care (IHC) assessments and Nursing Facility Level of Care Determinations (NFLOCDs) to evaluate members’ clinical, functional, cognitive, behavioral, and psychosocial needs; support accurate eligibility decisions and person-centered care planning; and ensure compliance with state Medicaid, LTSS, HCBS waiver, and regulatory requirements.
Required Qualifications
- Must reside in the state of Michigan (Wayne or Macomb Counties).
- Active Michigan license as a Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN), including Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS), with no disciplinary actions.
- Experience with Home and Community-Based Services (HCBS) and waiver programs.
- 2+ years of experience in healthcare and/or case management.
- Experience conducting Long-Term Services and Supports (LTSS) assessments, working with Medicaid regulations, and applying person-centered planning principles.
- Experience collaborating with interdisciplinary teams, providers, members, and caregivers to complete comprehensive assessments and recommend appropriate services.
- Demonstrated ability to maintain timely, accurate, and compliant documentation in accordance with organizational, state, and federal requirements.
- Knowledge of community health, social service agencies, and community resources.
- Ability to use electronic information systems and software programs, including electronic medical records (EMRs).
- Excellent keyboarding and web navigation skills.
- Intermediate to advanced computer skills, including experience with Microsoft Word, Outlook, and Excel.
Preferred Qualifications
- Bachelor of Science in Nursing (BSN)
- Experience completing InterRAI Integrated Health Care (IHC) Assessments, including assessment methodology, care planning, and identification of clinical, functional, cognitive, and psychosocial needs
- Experience conducting and documenting Nursing Facility Level of Care Determinations (NFLOCDs) in accordance with state Medicaid, Long-Term Services and Supports (LTSS), and regulatory requirements
- Experience in health promotion, coaching, and wellness
- Previous experience in managed care
Additional Information
- Schedule/Time Zone: Monday through Friday, 8:30 AM – 5:00 PM Eastern Time Zone
- Work Location: Michigan (Wayne and Macomb Counties)
- Work Style: Field
- Travel Requirements: 75%–90% travel within Wayne and/or Macomb Counties, Michigan
TB Statement: This patient-facing role is part of Humana’s Tuberculosis (TB) screening program. Candidates selected for this role must complete TB screening.
Driving Statement: This role is part of Humana’s Driver Safety Program and requires a valid state driver’s license and personal vehicle liability insurance. The individual must maintain coverage that meets the minimum requirements of their state of residence or $25,000 for bodily injury per person, $25,000 for bodily injury per event, and $10,000 for property damage, whichever is higher.
Eligible mileage includes
- Travel from your home to your first work location of the day.
- Travel between client or assignment locations during the workday.
- Travel from your final work location back to your home.
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.