Care Manager, Telephonic Nurse

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

📋 Description

• Ensure a consistent continuum of care for patients transitioning into and out of services.

• Act as a representative for CenterWell Home Health for discharged patients and those requiring post-acute services.

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

• Educate patients on different service sites, specialty offerings, post-acute care, and related inquiries.

• Address customer concerns including location searches, directions, and complaints.

• Assess the appropriate clinical level of care by reviewing discussions, medical records, and other clinical data.

• Align patient requirements with service locations or suggest alternative services if needed.

• Advocate for customers throughout the referral process to ensure prompt responses and enhance referral-to-admission conversion rates.

• Track and follow up on referral and admission outcomes.

• Oversee department performance metrics and patient satisfaction objectives.

• Support admissions by serving as an ambassador for qualified patients.

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

• Complete mandatory training on HIPAA, business ethics, compliance, and company policies.

• Provide information about home health, hospice, and palliative care services.

• Assist with clinical eligibility assessments for alternative services.

• Engage in special projects and undertake other assigned tasks.

• Report directly to the Care Management Manager.

⛳️ Requirements

• Associate's Degree is required; BSN is preferred.

• A compact state RN license is mandatory.

• Additional state licensures may be required based on business needs.

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

• Familiarity with home health, hospice, and palliative care services is essential.

• Capacity to learn and master information regarding client locations and services.

• Strong analytical and problem-solving skills.

• Excellent verbal and interpersonal communication abilities.

• Ability to convey empathy during phone communications.

• Proficiency in reading, writing, and speaking fluent English.

• Current CPR certification is required.

• A minimum internet speed of 25 Mbps download and 10 Mbps upload is necessary.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information is essential.

• Availability to work Monday to Friday from 9:00 a.m. to 5:30 p.m. EST, including weekend coverage every third weekend.

• Willingness to work a rotating holiday schedule.

• Availability for training outside of the advertised shift as needed.

🏝️ Benefits

• Medical benefits.

• Dental benefits.

• 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.

• Work-from-home arrangement.

• Occasional travel to Humana offices for training or meetings.