Location: Largo, FL
Additional Location: Tampa FL;
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 by guiding members/families toward and facilitate 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.
The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member’s physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Enhanced Care Coordination (ECC) ECC helps to connect children diagnosed with but not limited to chronic medical conditions, congenital conditions, developmental disabilities, and learning disabilities to care services. The ECC Case Manager (CM) assists families (if applicable) to coordinate care services while respecting the families right to decide the appropriate care setting for the child. ECC CM will collaborate with health care providers to develop a treatment plan that aligns the child with the appropriate care services. ECC improves communication among health care providers, member, parent/guardian, systems, and agencies. ECC CM help to reduce duplication of efforts, ease transitions of care, limit gaps between service providers, and secure transportation or other support / enabling services.
- Licensed Registered Nurse (RN) in the state of Florida with no disciplinary action or a Licensed Clinical Social Worker, LCSW
- Minimum 3 years ECC coordination experience which includes at least 2 years Pediatric acute care
- Minimum 1 year pediatric care management experience
- Intermediate or better working knowledge of Microsoft Office applications including Word, Excel, and Outlook
Additional Requirements / Adherence
Workstyle: Combination remote work at home and field based
Schedule: M-F 8:30 AM-5:00 PM coverage or overtime as business needs
Preferred: Pinellas County
- Typically, remote at home position with travel requirement at least 2 times monthly and as needed to support business needs.
Transportation: This role is part of Humana’s Driver safety program and therefore requires:
- Possession of a valid driver’s license and access to a reliable automobile
- Proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits. to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
Work at Home Guidance
- To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
TB and AHCA:
- This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
- AHCA Fingerprint Required.
- BSN degree
- A good understanding of AHCA regulations, NCQA and Medicaid guidelines
- Knowledge of Milliman or Interqual
- Managed care experience
- Certified Case Manager (CCM)
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
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