Care Manager, Telephonic Nurse

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

📋 Description

• Provide holistic and comprehensive case management throughout the entire continuum of care.

• Implement specialized case management interventions utilizing suitable care sites and levels of care.

• Aim to prevent or minimize hospital readmissions.

• Encourage the appropriate use of alternative funding sources.

• Improve care coordination and lessen the fragmentation of clinical services.

• Act as the primary point of contact for beneficiaries within the complex case management program across the clinical spectrum.

• Collaborate and coordinate with Care Management programs, Military Treatment Facility personnel, physicians, and other providers.

• Ensure that fully integrated care plans cater to all beneficiary needs and conditions.

• Report directly to the Manager of Care Management.

⛳️ Requirements

• U.S. citizenship is mandatory.

• Must successfully obtain interim approval for government security clearance (NBIS - National Background Investigation Services).

• Candidates residing in Puerto Rico are not eligible for hire.

• An active RN license in the state of employment is required.

• Ability to secure CCM certification within one year of employment.

• A minimum of 2 years of case management experience is necessary.

• At least 3 years of clinical RN or managed care RN experience is required.

• A Bachelor's degree in nursing is preferred.

• Experience with TRICARE is preferred.

• Familiarity with MCG is preferred.

• Current CCM certification is preferred.

• Capability to work an 8-hour shift between 8:00 a.m. and 6:00 p.m. EST, Monday to Friday.

• Availability for mandatory training from 8:00 a.m. to 5:00 p.m. EST during the first 4 weeks.

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

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

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Comprehensive 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 coverage.

• Long-term disability coverage.

• Life insurance.

• Support for personal wellness and smart healthcare decisions.

• Remote work arrangement.

• Home internet service support/requirements for remote work.

• Occasional travel to Humana offices for training or meetings.