[Hiring] Care Manager, Telephonic Nurse @Humana

Role Description

As a remote Telephonic Care Manager, you will report to a Manager of Care Management. You will be providing a comprehensive, holistic approach for the complex medical Case Management (CM) program throughout the continuum of care. Your responsibilities include:

• Providing case management specialized interventions by leveraging the most appropriate care sites and levels of care to prevent or decrease hospital readmissions.
• Promoting appropriate utilization of alternative sources of available funding.
• Enhancing coordination of care and reducing fragmentation of clinical services.
• Serving as the point of contact for the beneficiary for all activities within the clinical spectrum.
• Coordinating within the Care Management programs, Military Treatment Facility (MTF) Utilization Management/Case Management/CM staff, and providers to ensure a fully integrated care plan addressing all beneficiary needs and conditions.

Qualifications

• U.S. citizenship required for this position.
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services).
• Active RN license in state of employment.
• Ability to obtain CCM certification within 1 year of hire.
• 2 years case management experience.
• 3 years clinical RN or managed care RN experience.
• Must be able to work M - F, 8 a.m. - 5 p.m. ET or 9 a.m. - 6 p.m. ET.

Requirements

• Bachelor's degree in nursing (preferred).
• TRICARE experience (preferred).
• Experience with MCG (preferred).
• Current 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.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.