Location Type: Remote
Additional Location: OH; OH;
Humana Healthy Horizons in Ohio is seeking a Field Care Manager to assess and evaluate member’s 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.
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The Field Care Manager Nurse 2 (Care Manager Plus, Physical Health) work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Additional responsibilities for the PH CM are further defined by these two separate roles:
The PH CM must perform the full scope of care coordination activities and responsibilities for members who need care coordination and are not assigned to a Care Coordination Entity (i.e. the Ohio RISE Plan, and/or a CME, or who choose to receive their care management from the MCO). Care Manager serves as the single point of contact for care coordination.
The PH CM Plus must ensure the completion of the full scope of care coordination activities and responsibilities for members who need care coordination and are assigned to a Care Coordination Entity (i.e. the Ohio RISE Plan, CPCs, and/or a CMEs). Care Manager Plus serves as the single point of contact for care coordination.
- Ensuring the member receives the full scope of care coordination services, including comprehensive assessment completion (inclusive of the HRA), person-centered care plan completion, ensuring no duplication with the CCEs (Ohio RISE Plan, and/or CME), and identifying and addressing ongoing needs.
- Providing actionable data, information, and support to assist the CCE, Ohio RISE Plan, and/or CME in meeting the member’s care needs.
- Integrating information collected by the CCE into its Care Coordination Portal to minimize duplication.
The Field Care Manager Plus 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.
- Utilize a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs.
- Performs telephonic and face to face assessments and evaluations of the member’s needs to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member.
- Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.
- Perform clinical intervention through the development of a care plan specific to each member based on clinical judgement, changes in members’ health or psychosocial wellness, and identified triggers
- Collaborates with providers and community services to promote quality and cost-effective outcomes.
- Coordinates delivery of needed services/supports for Physical Health, Social Determinant of Health and value added benefits.
- Coordinates across the transdisciplinary care team (at a minimum the PCP) and transitions of care
- Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
- Submits incident reports
- Must reside in Ohio
- Licensed Registered Nurse (RN) in the state of Ohio without restrictions
- Minimum two (2) years of clinical experience
- Intermediate to advanced computer skills and experience with Microsoft Word, Outlook, and Excel; excellent keyboard and web navigation skills
- Exceptional communication and interpersonal skills with the ability to quickly build rapport
- Ability to work with minimal supervision within the role and scope
- Complete education and self-development activities per Humana Healthy Horizons and departmental requirements
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Case Management Certification (CCM)
- Experience working with Medicare, Medicaid and dual-eligible populations
- Field Case Management Experience
- Health Plan experience
- Knowledge of community health and social service agencies and additional community resources
- Experience with health promotion, coaching and wellness
- Bilingual (Spanish, Somali or other)
Workstyle: Combination remote work at home and onsite member visits
Location: Must reside in Ohio
Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM Eastern Time, over-time may be requested to meet business needs.
Travel: Must be willing to commute about 50% to meet with members.
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
Driver’s License, Transportation, Insurance This role is a part of Humana’s Driver Safety program and therefore requires and individual to have
- a valid state driver’s license
- proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits,
- and access to a reliable vehicle
Tuberculosis (TB) screening program
- This role is considered patient facing and is part of Humana At Home’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may 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. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen 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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