Care Manager, Telephonic Nurse

004 Humana Insurance Company; Oklahoma; Hybrid; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical, dental & vision benefits

401(k) plan

Paid time off & holidays

Travel for training/meetings as needed

Job summary

Humana, Inc. is seeking an Oklahoma-based Telephonic Care Manager who assesses enrollees, plans care, and coordinates services to maintain or achieve optimal wellness.

The role involves collaboration with a care management team and may require home or facility visits. Responsibilities include conducting telephonic and face-to-face assessments, developing enrollee care plans, tracking progress, and coordinating with providers to deliver cost-effective, high-quality care.

Qualifications

• Active RN license or LPC or LCSW certification.
• Minimum 1 year of clinical experience.
• 2+ years of care management experience.
• Experience coordinating Medicaid/Medicare enrollees’ services.
• Knowledge of community health resources and agencies.

Responsibilities

• Assess enrollees' health needs and plan appropriate care.
• Coordinate interactions with care management team and providers.
• Monitor progress toward desired health outcomes and adjust plans.
• Create enrollee care plans aligned with organizational goals.
• Perform telephonic and in-person assessments as needed.
• Travel to Humana Oklahoma offices for training and meetings when required.

Skills

Care management

Medicare/Medicaid experience

Microsoft Office

Education

Registered Nurse license

Licensed Professional Counselor (LPC)

Licensed Clinical Social Worker (LCSW)

Tools

Microsoft Word

Excel

PowerPoint

Job description

Become a part of our caring community You will work as an Oklahoma-based, telephonic care manager. This care manager will assess and evaluate enrollees' needs and requirements to achieve or maintain optimal wellness. The care manager will guide enrollees/families towards and facilitate interaction with appropriate resources for their care and wellbeing. The Care Manager, Telephonic Nurse 2 work assignments are varied but will focus on those enrollees with a primary physical health diagnosis. We are looking for interpretation and independent determination of appropriate actions and may require home or facility-based visits to enhance enrollee engagement and services. You will work in collaboration with the interdisciplinary care management team. This team includes community health workers, housing support specialists, SDOH coordinators, and care management support assistants. We design this team-based approach to ensure enrollees receive holistic person-centered care management. The Care Manager, Telephonic Nurse will utilize clinical expertise and experience to determine when face-to-face enrollee support is required. You will engage the appropriate members of the care management team and/or coordinate in-person meetings between the care manager and the enrollee. Possible travel to Humana Oklahoma office for meetings and training Use your skills to make an impact.

Responsibilities include:

• Employ a variety of strategies, approaches, and techniques to manage an Enrollee's behavioral, physical, environmental, and psycho-social health needs.
• Ensure Enrollees are progressing toward desired outcomes by continuously monitoring their assessments and evaluations.
• Identifies and resolves barriers that hinder effective care and ensures through continuous monitoring of assessments and evaluations that the Enrollee is progressing toward desired outcomes.
• Create Enrollee care plans, and understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Performs telephonic and face-to-face assessments and evaluations of the member's needs and requirements.
• These assessments aim to achieve and/or maintain an optimal wellness state.
• By guiding members/families toward the appropriate resources, the goal is to ensure the care and overall wellbeing of the member.
• Ensure member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.
• Create member care plans.
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Collaborate with providers and community services to promote quality and cost-effective outcomes.
• Follow established guidelines/procedures.

Required Qualifications

• Must reside in Oklahoma.
• Active Registered Nurse (RN) license, Licensed Professional Counselor (LPC), or Licensed Clinical Social Worker (LCSW)
• Minimum 1-year clinical experience.
• 2 or more years of care management.
• Experience working with Medicaid and/or Medicare Enrollees to coordinate services, care needs or benefits.
• Knowledge of community health and social service agencies and additional community resources.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint.

Preferred Qualifications

• Case Management Certification
• Bilingual Spanish Speaking

Work at Home Requirements

• To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: 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.
• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs.
• Humana reserves the right to require associates to upgrade their internet service if necessary.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Humana: 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. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

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.