Location Type: Remote
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) 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 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.
•The ECC team will provide a personalized approach to connect members with Humana programs and community partners to help members achieve their best health and access resources and services they need.
•ECC outreach telephonically and/or perform face-to-face visits. The goals of face-to-face visits are to provide another avenue of engagement into the case management program while assisting members to navigate the healthcare system, reduce high utilization, identify member barriers and gaps in care, reduce barriers in order to close gaps in care, and to improve engagement of identified members with complex needs.
- Active Licensed Registered Nurse, (RN) in the state of Florida with no disciplinary action
- Minimum 2 years clinical pediatric acute care experience
- Experience with pediatric case management, discharge planning and patient education for adult acute care
- Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook
Additional Information / Adherence
Workstyle: Remote work at home
- Monday through Friday 8:30-5:00 PM
- Opportunity to participate in a flexible schedule based on leader approval and business needs. (example: 4 10-hour shifts)
Travel: May be required to travel about 10% to meet with members or market office meetings
Work at Home Requirements
- 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.
Transportation: This role is part of Humana’s Driver safety program and therefore requires an individual to have
- Possession of a valid driver’s license and access to a reliable automobile
- a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
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.
- Bachelor’s degree
- Previous AHCA experience
- Prior experience working in care management within pediatric special needs population
- Previous private duty and/or skilled nursing Pediatric experience
- Utilization Management experience with knowledge of MCG or Interqual
- Managed care experience
- Certified Case Manager (CCM)
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Social Security Task
Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.
Scheduled Weekly Hours
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