Telephonic Nurse Case Manager

Humana; Kansas; Remote; USD 71,000 - 98,000; Full time

Job summary

Join a leading healthcare organization as a Telephonic Nurse Case Manager, providing comprehensive case management for TRICARE beneficiaries. You will assess and coordinate care, ensuring quality outcomes while maximizing self-care capacity. Ideal candidates will have an RN license and case management experience, with opportunities for professional growth.

Benefits

Comprehensive medical, dental, and vision benefits

401(k) plan

Paid time off

Disability and life insurance

Qualifications

• Current, valid RN license required.
• At least 2 years of case management experience.
• Active Certified Care Manager (CCM) designation or obtain within first year.

Responsibilities

• Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary.
• Utilize information sources to identify, assess, and enroll patients requiring case management.
• Coordinate with care management team to ensure integrated care plans.

Skills

Proficiency in Microsoft Office programs

Education

Associate’s degree in Nursing

Bachelor’s or Master’s degree in Nursing

Job description

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

Role: Telephonic Nurse Case Manager

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, within the scope of the case manager’s licensure. Responsibilities include assessing, planning, coordinating, implementing, monitoring, and evaluating the medical services required to meet the complex health needs of TRICARE beneficiaries, aiming to maximize self-care capacity, achieve clinical outcomes cost-effectively, and enhance quality of care.

Responsibilities

1. 35% Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary across the continuum of care. Develop cost-effective treatment plans considering psychosocial issues, home environment, and behavioral health needs, while maintaining privacy, confidentiality, and safety.
2. 30% Utilize information sources to identify, assess, and enroll patients requiring case management.
3. 25% Coordinate with care management team or external programs to ensure integrated care plans, documenting interventions and outcomes.
4. 10% Support Care Coordinators in managing beneficiaries not under case management as needed.

Qualifications

• U.S. citizenship required.
• Ability to obtain interim security clearance.
• Current, valid RN license and minimum Associate’s degree in Nursing.
• At least 2 years of case management experience.
• Active Certified Care Manager (CCM) designation or obtain within first year.
• Minimum 3 years of clinical nursing or managed care experience.
• Proficiency in Microsoft Office programs.

Preferred Qualifications

• Bachelor’s or Master’s degree in Nursing.
• Experience in Utilization Management/Review with MCG.
• Military experience and bilingual skills are a plus.

Work From Home Requirements

• High-speed internet with minimum 25x10 Mbps speed.
• Dedicated, interruption-free workspace.

Additional Information

Work hours: Monday – Friday, 8 a.m. – 6 p.m. EST; mandatory training for the first 4 weeks; occasional travel to Humana offices may be required.

Compensation and Benefits

Salary range: $71,100 - $97,800 annually, with potential bonuses. Humana offers comprehensive benefits including medical, dental, vision, 401(k), paid time off, disability, and life insurance.

About Humana

Humana is committed to health first, providing accessible healthcare services to improve quality of life for diverse populations, including military personnel and communities.

Equal Opportunity Employer

Humana does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status, and promotes affirmative action.