Humana

About Humana

 

Job Category:

Integrated Care & Care Operations - Care Management

Country:

United States

Approximate Salary:

Not Specified

Position Type:

Full Time

Care Manager, Telephonic Nurse 2 – Pediatric Special Population

Humana - Work At Home, Texas

Posted: 11/14/2018

Description

The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' 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 Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

ROLE SUMMARY

The Care Manager, Telephonic Nurse – Pediatric Special Population, will be a member of the HGB’s Population Health Department which focuses on those beneficiaries with unique care needs.  The care manager will offer guidance and support for the beneficiary’s care, specifically focusing case management efforts in the delivery of care to special populations; This program focuses on the ECHO/EHHC (Extended Care Health Options) (Enhanced Home Health Care) and ICMP/CCTP (Individual Case Management Program) (Custodial Care Transition Program); providing a comprehensive, holistic approach for care management throughout the continuum of care. 

The care manager will offer guidance and support of the beneficiary’s care as directed by the patient’s provider(s) and within the scope of the care manager’s licensure.  The care manager will assess, plan, coordinate, implement, monitor, and evaluate the medical services required to meet the complex health needs of TRICARE beneficiaries, to maximize each beneficiary’s capacity for self-care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care.   The case manager will collect and document data to facilitate measurement of case management involvement.  As part of the Population Health/ Special Population Team, the care manager, will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical spectrum, including collaboration with Behavioral Health Case Management on cases with dual diagnosis. 

They will also coordinate with other members of the Integrated Care Team (ICT) as needed, in addition to MTF UM / CM staff, physicians and providers as necessary and coordinate and arrange services necessary to address the beneficiary’s condition.  In their role, the Clinical Advisor, care manager, will collaborate/coordinate services with the ICT or other care management programs, to include, but not limited to, Transplants, NCI Clinical Trials, Humana at Home, New Beginnings, and End of Life services until the beneficiary’s needs are met and case closure or graduation is achieved.   Performs all duties within the scope of his/her licensure. 

Our Department of Defense Contract requires U.S. citizenship for this position.

Assignment Capsule

  • Utilize applicable sources of information to identify, assess, and enroll patients requiring case management
  • Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under Population Health/Special Population purview across the continuum of care.  Develop a cost effective treatment plan that is acceptable to both the beneficiary (patient) and other members of the care team utilizing both evidence based medical information, DoD and community resources.  Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care.  Maintain beneficiary’s privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.
  • Coordinate and collaborate with other members of the Special Populations, the ICT team or external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the care management programs.
  • Other duties as assigned.

               

Required Qualifications

  • Registered Nurse with current in state RN license
  • Certified Case Management
  • 2 years Case Management Experience
  •  “Knowledge” of Milliman Care Guidelines (MCG)         
  • Computer literate                                                                            
  • Good communication skills, verbal and written             
  • Good organizational skills
  • Must be available to work an 8 hour shift between 7:00 AM - 7:00 PM Central Standard Time hours
  • Our Department of Defense Contract requires U.S. citizenship for this position

Preferred Qualifications

  • Bachelor’s degree or health related field
  • TRICARE Experience
  • Home Health
  • Nursing experience in complex pediatrics

Additional Information

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive a correspondence inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Apply Now