[Hiring] Bilingual RN Field Care Manager @Humana

Role Description

The Field Care Manager Nurse 2 assesses members’ needs and helps members and their families access appropriate resources to achieve or maintain optimal health and well-being. The Field Care Manager Nurse 2 uses a range of strategies to address members’ physical, environmental, and psychosocial health needs.

• Must reside in Michigan and be able to drive to Wayne and/or Macomb Counties.
• This is a Field-based position requiring 75%–90% travel within an assigned area of Wayne and/or Macomb Counties to conduct in-home visits with Medicare and Medicaid members within a 30- to 40-mile radius.

Position Responsibilities:

• The RN Field Care Manager manages a caseload and completes member assessments in home, community-based, and telephonic settings.
• Provides clinical support and guidance, particularly for members with complex medical needs.
• Develops and coordinates care plans to ensure members receive appropriate services to manage their health effectively.
• Addresses barriers to healthcare and advocates for optimal member outcomes.
• Reviews, evaluates, and completes medical complexity attestations and clinical oversight activities.
• Assesses care needs to ensure members receive services in the least restrictive setting and achieve or maintain optimal well-being.
• Develops and updates the Individual Care Plan with applicable care team members, including informal caregivers, coaches, and primary care providers.
• Uses an interdisciplinary approach to help members and caregivers access social, housing, educational, and other services needed, regardless of funding source.
• Serves as the primary contact for the Interdisciplinary Care Team (ICT), coordinating with the member, ICT participants, and external resources to ensure the members’ needs are met.
• Conducts comprehensive InterRAI Integrated Health Care (IHC) assessments and Nursing Facility Level of Care Determinations (NFLOCDs) to evaluate members’ clinical, functional, cognitive, behavioral, and psychosocial needs; support accurate eligibility decisions and person-centered care planning; and ensure compliance with state Medicaid, LTSS, HCBS waiver, and regulatory requirements.

Qualifications

• Must reside in the state of Michigan (Wayne or Macomb Counties).
• Active Michigan license as a Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN), including Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS), with no disciplinary actions.
• Fluent in English and Arabic or Chaldean, with the ability to speak, read, and write each language independently and without assistance.
• Experience with Home and Community-Based Services (HCBS) and waiver programs.
• 2+ years of experience in healthcare and/or case management.
• Experience conducting Long-Term Services and Supports (LTSS) assessments, working with Medicaid regulations, and applying person-centered planning principles.
• Experience collaborating with interdisciplinary teams, providers, members, and caregivers to complete comprehensive assessments and recommend appropriate services.
• Demonstrated ability to maintain timely, accurate, and compliant documentation in accordance with organizational, state, and federal requirements.
• Knowledge of community health, social service agencies, and community resources.
• Ability to use electronic information systems and software programs, including electronic medical records (EMRs).
• Excellent keyboarding and web navigation skills.
• Intermediate to advanced computer skills, including experience with Microsoft Word, Outlook, and Excel.

Requirements

• Bachelor of Science in Nursing (BSN) preferred.
• Experience completing InterRAI Integrated Health Care (IHC) Assessments, including assessment methodology, care planning, and identification of clinical, functional, cognitive, and psychosocial needs.
• Experience conducting and documenting Nursing Facility Level of Care Determinations (NFLOCDs) in accordance with state Medicaid, Long-Term Services and Supports (LTSS), and regulatory requirements.
• Experience in health promotion, coaching, and wellness.
• Previous experience in managed care.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.

Additional Information

• Schedule/Time Zone: Monday through Friday, 8:30 AM – 5:00 PM Eastern Time Zone.
• Work Location: Michigan (Wayne and Macomb Counties).
• Work Style: Field.
• Travel Requirements: 75%–90% travel within Wayne and/or Macomb Counties, Michigan.
• This patient-facing role is part of Humana’s Tuberculosis (TB) screening program. Candidates selected for this role must complete TB screening.
• This role is part of Humana’s Driver Safety Program and requires a valid state driver’s license and personal vehicle liability insurance.
• Eligible mileage includes travel from home to the first work location of the day, travel between client or assignment locations during the workday, and travel from the final work location back to home.
• Work at Home Requirements: Minimum internet speed of 25 Mbps download and 10 Mbps upload is required.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours: 40.
• Pay Range: $71,100 - $97,800 per year, eligible for a bonus incentive plan.