DescriptionThe 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.
Location: Work from home anywhere preferably EST or CST but must be in a Compact State - Required hours are 9:30 a.m.– 6 p.m. EST or 8:30 a.m. 5 p.m. CST time zone -
Health Planning and Support (HP&S) is an inbound general nurse advice service, which provides Humana members with direct access to a nurse for guidance. The HP&S Telephonic Nurse 2 is trained to act as a clinical concierge, guiding members to resources, programs and/or healthcare providers for assistance with managing chronic conditions or for medical advice.
The HP&S Telephonic Nurse 2 assesses and identifies specialty program eligibility for members with increasing need for personal health guidance. The HP&S RN also places outbound calls to members for education and counseling on the importance of preventive screenings and treatment or medication adherence. The role is work at home, with oversight from the HP&S Manager, but the HP&S Telephonic Nurse 2 is expected to work independently with minimal supervision. The HP&S Telephonic Nurse 2 performs other duties as assigned.
- Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design
- Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally
- Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols
- Examine clinical programs information to identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria
- Conduct admission review, post-discharge calls and discharge planning
- Required hours are 9:30 a.m.– 6 p.m. EST or 8:30 a.m. 5 p.m. CST time zones.
- Must reside in a RN Compact State and have a Compact State License
- RN licensure, active and unrestricted
- At least 3 -5 years of clinical experience; preferably in an acute care, skilled or rehabilitation setting, home health, DME, triage, utilization, and case management
- Ability to work independently, and within a team
- Ability to multi-task via multiple computer systems, and talk and type at the same time
- Professional verbal and written communication skills
- Must have a private office with a locked door
- Minimal travel required
- High speed (10down x 1up minimum) DSL or cable modem service, which I am required to provide, is available in my geographic area. (If you are unsure, ask your local phone and/or cable company.)
- Bachelor’s degree in Nursing (BSN), or related healthcare field
- Previous Medicare experience and familiarity with CMS guidelines
- Previous experience in a call center
- Previous experience working from home
- Previous case management, utilization review, or triage experience
- Health plan operations experience
- Knowledge of Humana systems and clinical programs
- Bilingual – ability to speak fluently in both English and Spanish
Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Scheduled Weekly Hours40