About Humana


Job Category:

Integrated Care & Care Operations - Care Management


United States

Approximate Salary:

Not Specified

Position Type:

Full Time

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Case Manager, Special Population

Humana - Work At Home, Texas

Posted: 09/21/2018


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.


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.

The Care Manager for the Home Infusion and Pharmacy Management Program's will be a member of the Special Populations Team which focuses on those beneficiaries with unique care management needs. The clinician will offer guidance and support for the beneficiary’s care, specifically related to the beneficiary’s home infusion / medication needs; assist in coordinating care with multiple physicians and agencies to ensure all medications and services are provided as needed.  The Care Manager will provide personalized case management services to beneficiaries identified for the Pharmacy Management Program as a result of overutilization of narcotics; reviewing referral history, and working with the beneficiary to coordinate care with multiple specialists, facilities and providers.  The Care Manager will assess, plan, coordinate, implement, monitor, and evaluate the services required to meet the complex health needs of these beneficiaries. The Care Manager will assist in coordinating services including coordination with the behavioral health team. The clinician will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical spectrum, including collaboration with other care management programs and behavioral health.  They will coordinate with members of the Integrated Care Team as needed, in addition to MTF UM / CM staff, physicians and providers as necessary to coordinate and arrange services necessary to address the beneficiary’s condition or needs; to include claims review and claims processing.  The Care Manager will always perform all duties within the scope of his/her licensure.


Required Qualifications

  • Registered Nurse with current in state RN license
  • Certified Case Management
  • 2 years Case Management Experience
  • Interqual (or Milliman) knowledge 
  • Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook
  • Good communication skills, verbal and written
  • Good organizational skills
  • Our Department of Defense Contract requires U.S. citizenship for this position
  • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Preferred Qualifications

  • Bachelors degree or health related field
  • Experience in claims processing/claims review
  • TRICARE Experience
  • Utilization Management Experience

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


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