RN Care Manager - Remote, nationwide

📋 Description

• • As a Telephonic Nurse Care Manager 2 at Humana, you will play a pivotal role in our mission to put health first by managing the physical, environmental, and psycho-social health of members with complex needs.
• • This role is integral to our Special Needs Program (SNP), focusing on members with multiple chronic conditions and significant barriers to achieving optimal health and independence.
• • You will conduct comprehensive telephonic assessments of Medicare, Medicaid, and Group Account members, leveraging your clinical expertise to develop personalized, actionable, and measurable care plans.
• • Your primary responsibility will be to guide and track member progress towards their health goals, ensuring they receive the support and resources necessary for successful outcomes.
• • A key aspect of this role involves utilizing your nursing judgment to assess and coordinate care for acute situations, including responding to Advance Practice Services (APS) and Emergency Medical Services (EMS) calls.
• • You will facilitate safe transitions of care, assisting members with discharge planning to their homes and coordinating essential services such as Durable Medical Equipment (DME), home health care, and provider appointments.
• • A significant part of your day will involve guiding members and their families toward appropriate community and healthcare resources, empowering them to manage their well-being effectively.
• • You will collaborate closely with a multidisciplinary team, including social workers, dietitians, and pharmacists, employing a variety of strategies and techniques to address member needs and provide timely interventions.
• • This position requires a high degree of autonomy in decision-making, troubleshooting, and problem-solving, particularly concerning periodic system issues that may arise.
• • You will be expected to manage multiple or competing priorities efficiently, often utilizing dual computer monitors and navigating several applications simultaneously in a fast-paced environment.
• • The role demands exceptional telephonic and virtual communication skills to engage effectively with members and convey complex information clearly.
• • A dedicated, private home office space with a locked door is mandatory to ensure the absolute and continuous privacy of member Protected Health Information (PHI) and HIPAA compliance.
• • The initial four weeks of training will be conducted from 8:30 AM to 5:00 PM EST, with no time off permitted during this critical onboarding period.
• • Following successful completion of training, your regular work schedule will commence at 10:00 AM EST.
• • This is a compliance-driven and highly visible program, requiring adherence to strict protocols and guidelines.
• • You will primarily interact with members via telephone, often utilizing an auto-dialer system, necessitating the ability to engage quickly and efficiently while managing multiple computer applications.
• • Due to the nature of the auto-dialer process and compliance requirements, there is limited day-to-day flexibility in scheduling.
• • Your work will directly contribute to improving the quality of life for millions of people by helping them navigate complex health challenges and achieve better health outcomes.
• • You will be instrumental in Humana's commitment to putting health first, fostering a supportive community for both members and colleagues.
• • This role offers the opportunity to make a tangible impact on individuals' lives, providing essential support and guidance in their healthcare journeys.
• • You will be part of a dynamic and evolving healthcare landscape, contributing to innovative care management solutions.
• • The position requires a proactive approach to identifying and resolving barriers that hinder effective care delivery and member progress.
• • Continuous monitoring of patient care through assessments and evaluations is crucial to ensure members are progressing towards their desired health outcomes.
• • You will be expected to maintain advanced communication and interpersonal skills to build rapport and trust with members over the phone.
• • The ability to adapt to new technologies and processes quickly will be essential for success in this role.
• • This role is ideal for a compassionate and skilled RN who thrives in a remote work environment and is dedicated to patient advocacy and comprehensive care management.