Care Manager, Telephonic Nurse

Humana; Teletrabalho; BRL 385.000 - 531.000; Tempo integral

Resumo da oferta

A health-focused insurance company is seeking a Care Manager, Telephonic Nurse to utilize clinical skills for medical service coordination. The role involves assessing member health needs, facilitating access to benefits, and requires a valid RN license. Candidates must have a minimum of 3 years acute care experience. This full-time position offers competitive pay, a hybrid work model, and various benefits to support employee well-being.

Serviços

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Short-term and long-term disability

Life insurance

Qualificações

• Minimum of 3 years of clinical acute care experience.
• Licensed Registered Nurse (RN) with no disciplinary action.
• Must have a valid Compact RN license.

Responsabilidades

• Utilize clinical nursing skills to support medical services coordination.
• Facilitate member access to Humana benefits.
• Assess member health issues and intervene appropriately.

Conhecimentos

Clinical nursing skills

Communication skills

Critical thinking

Knowledge of Microsoft programs

Formação académica

Associate's degree in Nursing

Bachelor's degree - BSN

Descrição da oferta de emprego

Become a part of our caring community and help us put health first

The Care Manager, Telephonic Nurse utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Associate will be expected to participate in weekend rotation a minimum of one hour each on Saturday and Sunday once every 17 weeks.

Work schedule can be between 8am-6:30pm EST.

The Care Manager Telephonic Nurse uses clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. 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.

The Care Manager Telephonic Nurse employs a variety of strategies, approaches and techniques to assess, intervene, and resolve Access to Care (ATC) barriers related to immediate medical services. The nurse will facilitate verified eligible Humana benefits to a provider and/or member while effectively documenting through assessments and/or evaluations while maintaining compliance with CMS regulations. The Care Manager Telephonic Nurse must also assess for member physical, environmental, and psycho-social health issues and intervene appropriately.

Use your skills to make an impact

Required Qualifications

• Minimum of an Associate’s degree in Nursing
• Licensed Registered Nurse (RN) with no disciplinary action
• Must have a valid Compact RN license in the state where they reside. Candidates must reside in a Compact state (excluding CA, IL, MI, NY, OR, AK, DC (District of Columbia), HI, NV, MA, MN, and PR).
• 3 years or more of clinical acute care experience
• Comprehensive knowledge of all Microsoft programs including but not limited to Word, Outlook, PowerPoint, SharePoint, OneNote and Excel

Preferred Qualifications

• Bachelor's degree - BSN
• Experience with case management, discharge planning, and patient education for adult acute care
• Managed care experience
• Previous Medicare/Medicaid experience
• Bilingual English/Spanish

Additional Information

• Associate will be expected to participate in weekend rotation a minimum of one hour each on Saturday and Sunday once every 17 weeks.
• Work schedule can be between 8am-6:30pm EST.

Work At Home / Internet Statement

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees 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 employees 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.

SSN Alert Statement

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [e-mail] with instructions on how to add the information into your official application on Humana’s secure website.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 01-04-2026

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.