Care Manager, Telephonic Nurse

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist patients who have been discharged from CenterWell Home Health services or are in need of post-acute services.

• Guide patients through healthcare options, post-acute care services, Medicare coverage, billing concerns, and available healthcare resources.

• Provide education and options to patients regarding service locations, specialty services, post-acute care, and related inquiries.

• Resolve customer issues, including location searches, directions, and complaints.

• Assess the clinical level of care through discussions, medical records, and clinical data.

• Connect patients to suitable service locations or suggest alternative services.

• Advocate for patients throughout the referral process.

• Track and follow up on referral and admission outcomes.

• Uphold departmental performance standards and patient satisfaction metrics.

• Support admissions by assisting patients who fulfill the admission criteria.

• Ensure the right patient is placed in the appropriate care setting at the right time.

• Complete required training on HIPAA, Business Ethics and Compliance, and company policies.

• Educate about Home Health, Hospice, and Palliative Care Services.

• Support clinical eligibility assessments for alternative services.

• Engage in special projects and undertake other assigned duties.

• Report directly to the Manager of Care Management.

• Work a 40-hour schedule over four days, including rotating weekend and holiday shifts.

⛳️ Requirements

• An Associate's Degree is required.

• A BSN is preferred.

• A Compact state RN license is required; additional state licenses may be necessary based on business needs.

• A minimum of 3 years of post-acute nursing experience is required.

• Experience in home health or hospice is preferred.

• Knowledge of home health, hospice, and palliative care services is essential.

• Ability to learn and master details related to client locations and available services.

• Strong analytical and problem-solving skills.

• Excellent verbal and interpersonal communication abilities.

• Ability to communicate empathetically over the phone.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload is necessary.

• A dedicated workspace free from distractions to safeguard member PHI/HIPAA information is required.

• Availability for a rotating holiday schedule is necessary.

• Willingness to train outside of the advertised shift when needed.

🏝️ Benefits

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Personal wellness support.

• Smart healthcare decision support.

• Occasional travel to Humana offices for training or meetings.