[Hiring] Care Manager, Telephonic Registered Nurse @Humana

Role Description

Become a part of our caring community. Humana Care Support is a division of Humana dedicated to helping adults remain independent in their homes. In this role, you'll serve as a trusted advocate and partner, helping members navigate the healthcare system and achieve their health goals through compassionate, person-centered care.

• Partner with members and their families to improve health outcomes through comprehensive assessment, care coordination, and ongoing support.
• Help members remain independent in their homes by identifying healthcare needs, removing barriers to care, and connecting members with clinical, community, and social resources.
• Telephonically support Medicare members with transitional care needs and complex chronic conditions.
• Assess members' physical, environmental, behavioral, and psychosocial health needs.
• Continuously assess member progress and adjust care interventions to support optimal health outcomes.
• Develop, implement, and monitor individualized care plans as appropriate.
• Connect members and families with appropriate healthcare, community, and social service resources.
• Coordinate care and collaborate with interdisciplinary teams to address member needs and improve outcomes.
• Employ a variety of clinical strategies and interventions to manage member health concerns.
• Evaluate member risk factors and implement interventions designed to prevent avoidable hospitalizations and emergency department utilization.
• Identify and address barriers to care, including social, financial, environmental, and functional challenges.
• Exercise sound clinical judgment and independent decision-making in a fast-paced care management environment.

Qualifications

• An active, unrestricted Registered Nurse (RN) license in state of residence with active Compact (Multistate) licensure with no disciplinary action.
• Three (3) or more years of clinical acute care experience, including case management, discharge planning, and patient education for adult populations.
• Demonstrated clinical expertise managing chronic conditions through assessment, care coordination, clinical intervention, and individualized care planning.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Proficiency with Microsoft Office (Word, Excel, Outlook) and the ability to efficiently navigate multiple systems and applications simultaneously, including dual-monitor environments.
• Ability to manage multiple priorities in a fast-paced, telephonic care management environment.
• Advanced verbal and written communication skills, including the ability to effectively engage members through telephonic and virtual interactions.

Requirements

• BSN or MSN degree (preferred).
• Managed care experience (preferred).
• Certified Case Manager (CCM) (preferred).
• Bilingual (English and Spanish); with the ability to read, write, and speak in both languages with no limitations or assistance (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 supporting whole-person well-being.

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.