Care Manager, Telephonic Nurse

Telephonic Care Manager

As a remote Telephonic Care Manager you will report to a Manager of Care Management. You will be providing a comprehensive, holistic approach for the complex medical Case Management (CM) program throughout the continuum of care. You will provide case management specialized interventions by leveraging the most appropriate care sites and levels of care to prevent or decrease hospital readmissions, promoting appropriate utilization of alternative sources of available funding, enhancing coordination of care, and reducing fragmentation of clinical services.

You will serve as the point of contact for the beneficiary for all activities within the clinical spectrum. You will coordinate within the Care Management programs, Military Treatment Facility (MTF) Utilization Management/Case Management/CM staff, and providers to ensure there is a fully integrated care plan addressing all beneficiary needs and conditions.

Use Your Skills To Make An Impact

Required Qualifications

• U.S. citizenship for this position.
• Successfully receive interim approval for government security clearance.
• Active RN license in state of employment.
• Ability to obtain CCM certification within 1 year of hire.
• 2 years case management experience.
• 3 years clinical RN or managed care RN experience.
• Must be able to work M - F, 8 a.m. - 5 p.m. ET or 9 a.m. - 6 p.m. ET.

Preferred Qualifications

• Bachelor's degree in nursing.
• TRICARE experience.
• Experience with MCG.
• Current CCM.

Additional Information

Work Style: Remote Work Schedule: Monday – Friday; must be able to work an 8-hour shift between the hours of 8:00 a.m. – 6 p.m. ET (Eastern Time)

Training/Training Hours: Mandatory for the first 4 weeks between the hours 8:00 a.m. – 5:00 p.m. ET (Eastern Time)

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 $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 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

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 at Humana.com and at CenterWell.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.