Care Manager, Telephonic Nurse

Shift/availability Details Full time 40 hours a week scheduled for 8 hour shifts, 5 days a week. The schedule is Monday-Friday from 9am-5:30pm EST. Required weekend coverage every 3rd weekend on Saturday & Sunday from 9am-5:30pm EST. When working weekends, it will allow for days off during the week. Required to work a rotating holiday schedule. A vailable to train on days or times outside of the shift advertised. Schedule and shift changes may be required based on patient care needs and business demands. Work Description This is a work-from-home telephonic Registered Nurse position. As a Care Manager, Telephonic Nurse, you will report directly to the Manager, Care Management. You will help to ensure optimal continuity of care for patients transitioning into and out of our services. You will be responsible for being knowledgeable regarding post-acute levels of care, and an expert regarding CenterWell Home Health services including home health, hospice, and palliative care. You will communicate with the CenterWell Home Health clinical team and help facilitate patient follow-up for patients in need of (additional) services. Essential Functions Be a CenterWell Home Health representative in supporting patients who have been discharged from service or for those who may need post-acute services. Navigate healthcare options; care services post-acute offerings, Medicare coverage, billing issues, and accessing healthcare resources. Use a variety of tools and methods to quickly provide patient options and education including but not limited to sites of service, specialty offerings, post-acute care, and other related questions. Handle a variety of customer issues including location lookup, directions, and complaints. Make clinical level of care determination based on discussion, medical records, and any other important clinical data. Match these needs to a service site location or, if not available, look up and provide alternative services. Be a customer advocate throughout the referral process to ensure timely response and to maximize referral to admission conversion rate. Follow-up and track referral and admission outcomes. Maintain awareness and orientation to department performance objectives, meets standards, and assures patient satisfaction goals are met. Assist in the admissions process by acting as an ambassador for patients who meet the admissions requirements. Focus on placing the right patient to the right care setting at the right time. Adhere to and participates in Company's mandatory training which includes but is not limited to HIPAA privacy program/practices, Business Ethics and Compliance programs/practices, and Company policies and procedures. Review and adhere to all Company policies and procedures. Provide education regarding Home Health, Hospice, and Palliative Care Services. Help with clinical eligibility review for alternate services. Participate in special projects and perform other responsibilities as assigned. Use your skills to make an impact. Requirements Associates Degree required. BSN preferred. We require a compact state RN license. Business needs may require additional state licensures be obtained. At least 3 years post-acute nursing experience. Home health or hospice experience preferred. Knowledge of home health, hospice, and palliative care services. Learn and master information related to locations and services of clients. Analytical and can problem-solve. Excellent verbal and interpersonal skills. Communication with empathy over the phone. 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. Salary and Benefits Scheduled Weekly Hours - 40 Pay Range - $71,100 - $97,800 per year 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. #J-18808-Ljbffr humana