[Hiring] Care Manager, Telephonic Nurse @Humana

Role Description

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. The Care Manager guides members/families toward and facilitates 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. You will report to the Associate Director, Health Services Nursing.

Responsibilities:

• Conducts telephonic assessments to identify members’ clinical, behavioral, social, and environmental needs.
• Identifies and resolves barriers that hinder effective care or treatment adherence.
• Develops, implements, and updates individualized care plans, as appropriate.
• Monitors member progress toward desired outcomes through ongoing assessment and evaluation.
• Provides education and support for chronic conditions management and self-care.
• Coordinates care and facilitates access to appropriate providers, services, and community resources.
• Collaborates with members, families, providers, and interdisciplinary teams to support care goals.
• Maintains timely and accurate documentation in accordance with established guidelines and quality and compliance requirements.
• Applies department, segment, and organizational policies, procedures and operational objectives in day to day work to support established strategy and operating objectives.
• Exercises independent judgment and utilizes available resources in managing assigned caseloads, occasionally in ambiguous situations, with minimal direction and guidance.
• Up to 20% travel may be required due to business needs, including member outreach and meetings.
• This position primarily works standard business hours; however, schedule flexibility may be required based on business needs.

Qualifications

• Active, unrestricted Registered Nurse (RN) license in the state of South Carolina with multistate compact privileges and no disciplinary action.
• Must reside in the state of South Carolina.
• 3+ years of recent acute care clinical nursing experience.
• Experience providing education and support for chronic condition management.
• Experience with community resource coordination.
• Proficiency with Microsoft Office applications, including Word, Excel, and Outlook.
• Strong documentation, multitasking, and computer navigation with basic troubleshooting skills.

Requirements

• Bachelor of Science in Nursing (BSN) (Preferred).
• Experience in telephonic case management, care management, discharge planning, transitions of care and patient education in an adult acute care setting (Preferred).
• Managed care experience (Preferred).
• Medicare & Medicaid population experience (Preferred).
• Behavioral health management awareness (Preferred).
• Telephonic nursing experience (Preferred).
• Certified Case Manager (CCM) (Preferred).

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.
• Many other opportunities.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.