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.
Health Planning and Support (HP&S) is an inbound call center, general nurse advice line. A Telephonic Nurse 2 provide general medical guidance, screens for program referrals, provides information on the importance of preventive screenings or medication adherence; and is trained to act as a clinical concierge.
The HP&S Telephonic Nurse 2 role is work at home, with oversight from the HP&S Manager; and they are expected to work independently with minimal supervision. The HP&S Telephonic Nurse 2 performs other duties as assigned.
- Provide accurate and appropriate general medical advice utilizing approved medical resources
- Using established screening criteria identify members for specific case management and or disease management or interventions
- Utilizing available resources and benefits ensure member is aware of and participating in all programs and services offered
- Ensure members are receiving preventative health care services, complaint with all medications and assist with coordinating any/all needed care
- Educate and assist member with plan education; offer support with managing network participation by using your knowledge of members benefit plan and Humana approved resources
- Required hours are 9:00 – 5:30 pm EST
- Must reside in a RN Compact State and have a Nursing Compact Multi 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
- Previous experience in a call center
- 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
- High speed DSL or cable modem service (10 Mbps down x 1Mbps up, Minimum), which applicant is required to provide
- Minimal travel required
- Must be able to work the hours of 9:00 - 5:30 pm EST
- Bachelor’s degree in Nursing (BSN), or related healthcare field
- Previous case management, utilization review, or triage experience
- Previous Medicare experience and familiarity with CMS guidelines
- Previous experience working from home
- 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