Telephonic Nurse Case Manager

Humana; Georgia (VT); Remote; USD 71,000 - 98,000; Full time

Job summary

Join a leading healthcare company as a Telephonic Nurse Case Manager, where you'll provide comprehensive case management for TRICARE beneficiaries. This role involves assessing and coordinating care, ensuring quality outcomes, and collaborating with healthcare teams. Ideal candidates will have a valid RN license, case management experience, and the ability to work effectively in a remote environment.

Benefits

Medical, dental, and vision insurance

401(k) plan

Paid time off

Disability and life insurance

Qualifications

• Valid and unrestricted license as a Registered Nurse (R.N.).
• Minimum 2 years of case management experience.
• Active Certified Care Manager (CCM) designation required within the first year.

Responsibilities

• Assess, plan, coordinate, implement, monitor, and evaluate care for beneficiaries.
• Coordinate with other members of the care management team.
• Support Care Coordinators with care coordination as needed.

Skills

Proficiency in Microsoft Office programs

Bilingual in Spanish and English

Motivational interviewing techniques

Education

Associate’s degree in Nursing

Bachelor’s or Master’s degree in Nursing

Job description

2 days ago Be among the first 25 applicants

This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$71,100.00/yr - $97,800.00/yr

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

The Telephonic Nurse Case Manager will be a member of the Case Management Team, providing a comprehensive, holistic approach for case management throughout the continuum of care. The case manager will offer guidance, support, and coordination of the beneficiary’s care as directed by the beneficiary, the provider(s), or other members of the healthcare team and within the scope of the case manager’s licensure. The case manager will assess, plan, coordinate, implement, monitor, and evaluate the medical services required to meet the complex health needs of TRICARE beneficiaries, to maximize each beneficiary’s capacity for self-care, to cost-effectively achieve desired clinical outcomes, and to enhance quality of medical care. The case manager will collect and document data to facilitate measurement of case management involvement. The case manager will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical and behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN), MTF UM / CM staff, physicians, and providers as necessary; organize, arrange, and coordinate services necessary to address the beneficiary’s condition. In their role, the Case Manager will collaborate with other care management programs until the beneficiary’s needs are met and case closure or graduation is achieved. Performs all duties within the scope of licensure.

Role Responsibilities

1. 35% Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the Case Management purview across the continuum of care. Develop a cost-effective treatment plan that is acceptable to both the beneficiary (patient) and other members of the care team utilizing evidence-based medical information, DoD, and community resources (SDOH). The plan shall include psychosocial issues, home environment, and behavioral health needs across the full continuum of care. Maintain beneficiary’s privacy, confidentiality, and safety, advocating and adhering to ethical, legal, and regulatory standards during this process.
2. 30% Utilize applicable sources of information to identify, assess, and enroll patients requiring case management.
3. 25% Coordinate and collaborate with other members of the care management team or external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; document interventions and outcomes for beneficiaries within the case management team.
4. 10% Support the Care Coordinators with the coordination of care for beneficiaries not under case management as needed.

Required Qualifications

• U.S. citizenship is required for this Department of Defense Contract.
• Successfully receive interim approval for government security clearance (eQIP).
• HGB is not authorized to work in Puerto Rico per our government contract. Candidates residing in Puerto Rico are not eligible.
• Valid and unrestricted license as a Registered Nurse (R.N.).
• Minimum Associate’s degree in Nursing.
• 2 years of case management experience.
• Active Certified Care Manager (CCM) designation; if not active at hire, must be obtained within the first year.
• 3+ years of clinical nursing or managed care experience.
• Proficiency in Microsoft Office programs (Word, Excel, Outlook).

Preferred Qualifications

• Bachelor’s or Master’s degree in Nursing.
• Experience in Utilization Management/Utilization Review with MCG.
• Military experience a plus.
• Bilingual in Spanish and English.
• Experience with motivational interviewing techniques.

Work At Home/Remote Requirements

• High-speed DSL or cable internet connection required; satellite and wireless internet not permitted.
• Dedicated, interruption-free workspace to protect PHI/HIPAA information.

Additional Information

Work Days/Hours: Monday – Friday, 8 a.m. – 6 p.m. EST (8-hour shift).

Training Hours: First 4 weeks, 8 a.m. – 5 p.m. EST.

Travel: Occasional travel to Humana offices for training/meetings may be required.

Scheduled Weekly Hours: 40.

Pay Range: $71,100 - $97,800 annually, based on location, skills, and experience. Eligible for performance-based bonus.

Benefits: Medical, dental, vision, 401(k), paid time off, disability, life insurance, and more.

About Humana: Committed to health and well-being through insurance and healthcare services, serving diverse populations including Medicare, Medicaid, military personnel, and communities.

Equal Opportunity Employer: Humana values diversity and inclusion, and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, disability, or veteran status.