Telephonic Nurse Case Manager

Field Care Manager Nurse 2The 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.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 QualificationsMust 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.Fluent in English and Arabic or Chaldean, with the ability to speak, read, and write each language independently and without assistance.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 QualificationsBachelor 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 needsExperience conducting and documenting Nursing Facility Level of Care Determinations (NFLOCDs) in accordance with state Medicaid, Long-Term Services and Supports (LTSS), and regulatory requirementsExperience in health promotion, coaching, and wellnessPrevious experience in managed careAdditional InformationSchedule/Time Zone: Monday through Friday, 8:30 AM – 5:00 PM Eastern Time ZoneWork Location: Michigan (Wayne and Macomb Counties)Work Style: FieldTravel Requirements: 75%–90% travel within Wayne and/or Macomb Counties, MichiganTB 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 Hours40Pay RangeThe 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 BenefitsHumana, 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.