RN Field Care Manager - Medicaid HCBS/LTSS

Become a part of our caring community The Field Care Manager Nurse 2 assesses members’ needs and helps members and their families access appropriate resources to achieve or maintain optimal health and well-being. Become a part of our caring community The Field Care Manager Nurse 2 assesses members’ needs and helps members and their families access appropriate resources to achieve or maintain optimal health and well-being. The Field Care Manager Nurse 2 uses a range of strategies to address members’ physical, environmental, and psychosocial health needs. Must reside in Michigan and be able to drive to Wayne and/or Macomb Counties. This is a Field-based position requires 75%–90% travel within an assigned area of Wayne and/or Macomb Counties to conduct in‑home visits with Medicare and Medicaid members within a 30- to 40‑mile radius. Position Responsibilities The RN Field Care Manager manages a caseload and completes member assessments in home, community-based, and telephonic settings. Provides clinical support and guidance, particularly for members with complex medical needs. Develops and coordinates care plans to ensure members receive appropriate services to manage their health effectively. Addresses barriers to healthcare and advocates for optimal member outcomes. Reviews, evaluates, and completes medical complexity attestations and clinical oversight activities. Assesses care needs to ensure members receive services in the least restrictive setting and achieve or maintain optimal well-being. Develops and updates the Individual Care Plan with applicable care team members, including informal caregivers, coaches, and primary care providers. Uses an interdisciplinary approach to help members and caregivers access social, housing, educational, and other services needed, regardless of funding source. Serves as the primary contact for the Interdisciplinary Care Team (ICT), coordinating with the member, ICT participants, and external resources to ensure the members’ needs are met. Conducts comprehensive InterRAI Integrated Health Care (IHC) assessments and Nursing Facility Level of Care Determinations (NFLOCDs) to evaluate members’ clinical, functional, cognitive, behavioral, and psychosocial needs; support accurate eligibility decisions and person-centered care planning; and ensure compliance with state Medicaid, LTSS, HCBS waiver, and regulatory requirements. Required Qualifications Use your skills to make an impact Must reside in the state of Michigan (Wayne or Macomb Counties). Active Michigan license as a Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN), including Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS), with no disciplinary actions. Experience with Home and Community-Based Services (HCBS) and waiver programs. 2+ years of experience in healthcare and/or case management. Experience conducting Long-Term Services and Supports (LTSS) assessments, working with Medicaid regulations, and applying person-centered planning principles. Experience collaborating with interdisciplinary teams, providers, members, and caregivers to complete comprehensive assessments and recommend appropriate services. Demonstrated ability to maintain timely, accurate, and compliant documentation in accordance with organizational, state, and federal requirements. Knowledge of community health, social service agencies, and community resources. Ability to use electronic information systems and software programs, including electronic medical records (EMRs). Excellent keyboarding and web navigation skills. Intermediate to advanced computer skills, including experience with Microsoft Word, Outlook, and Excel. Preferred Qualifications Bachelor of Science in Nursing (BSN) Experience completing InterRAI Integrated Health Care (IHC) Assessments, including assessment methodology, care planning, and identification of clinical, functional, cognitive, and psychosocial needs Experience conducting and documenting Nursing Facility Level of Care Determinations (NFLOCDs) in accordance with state Medicaid, Long-Term Services and Supports (LTSS), and regulatory requirements Experience in health promotion, coaching, and wellness Previous experience in managed care Additional Information Schedule/Time Zone: Monday through Friday, 8:30 AM – 5:0 PM Eastern Time Zone Work Location: Michigan (Wayne and Macomb Counties) Work Style: Field Travel Requirements: 75%–90% travel within Wayne and/or Macomb Counties, Michigan TB Statement: This patient-facing role is part of Humana’s Tuberculosis (TB) screening program. Candidates selected for this role must complete TB screening. Driving Statement This role is part of Humana’s Driver Safety Program and requires a valid state driver’s license and personal vehicle liability insurance. The individual must maintain coverage that meets the minimum requirements of their state of residence or $25,000 for bodily injury per person, $25,000 for bodily injury per event, and $10,000 for property damage, whichever is higher. Eligible Mileage Includes Travel from your home to your first work location of the day. Travel between client or assignment locations during the workday. Travel from your final work location back to your home. 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. #J-18808-Ljbffr