DescriptionThe Senior Case Manager, 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 Senior Case Manager work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Role: Senior Case Manager, RN
Location: Work at Home, Intermountain Region (WA, OR, ID or UT)
Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Experience means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.
Be a part of our Clinical Space – as a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.Humana is seeking a Senior Case Manager who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.
Preferred applicants will live in the Pacific or Mountain time zones, possess three years of varied clinical nursing experience including case management, and have a work at home or telephonic background. Must possess excellent verbal and written communication skills and the ability to work in a fast paced environment. Responsibilities include:
- 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
- Active RN license in the state(s) in which the nurse is required to practice
- Ability to be licensed in multiple states without restrictions
- Minimum of three years prior nursing experience preferably in an acute care, skilled or rehabilitation clinical setting
- Proficient with MS Office products including Word, Excel and Outlook
- Ability to work independently under general instructions and with a team
- Valid drivers license and/or dependable transportation necessary (variable by region)
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10Mx1M
- Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.
- Washington, Utah, Idaho or Oregon residency preferred
- Education: BSN or Bachelor’s degree in a related field
- Experience in case management
- Certification in Case Management a plus (CCM)
- Health Plan experience
- Previous Medicare/Medicaid experience
- Prior experience in a work at home and telephonic role
- Previous experience in utilization management, discharge planning and/or home health or rehab
Scheduled Weekly Hours40