Description

The Telephonic Nurse Care Manager will be part of the Humana Military Care Management team; providing a comprehensive, holistic approach for Disease Management and Personal Nurse programs throughout the continuum of care. The nurse will have personal interaction with beneficiaries to address clinical conditions identified through Predictive Analytics helping them develop healthy behaviors, understand their condition/disease, coping skills and treatment plan adherence; leading to decreased risk of progression into a disease and symptoms and complications of the condition/disease. The Telephonic Nurse Care Manager will assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary required to meet the health needs of TRICARE beneficiaries, to maximize each beneficiary’s capacity for self-care to enhance quality of medical care and achieve desired clinical outcomes.

Responsibilities

As part of the Care Management Team, the Telephonic Nurse Care Manager will serve as the primary coordinator and point of contact for the beneficiary for all activities within the clinical spectrum. This will include coordination and collaboration within the Care Management programs, Military Treatment Facility (MTF) UM/CM/DM staff, physicians or providers to ensure there is a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the Care Management program. Performs all duties within the scope of his/her licensure.

Additional responsibilities include:

• Provide telephonic care guidance support to beneficiaries and their family/caregiver to ensure education, care coordination and support measures are in place; according to the established plan of care

• Assess beneficiary needs and develop a personalized plan of care from the assessment findings; in coordination with the beneficiaries’ physician

• Conduct assessments to identify gaps in care, eligibility for assistance and/or need for care management program or other referral services in collaboration with Humana Government Business

• Utilize Motivational Interviewing and solution-oriented approaches in communication delivery

• Identify Social Determinants of Health needs and/or community resources to provide services

• Maintain beneficiary’s privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process

• Ensure adherence to policies and performance standards in accordance with the URAC, TRICARE Operations Manual (TOM), TRICARE Provider Manual (TPM) or any other Defense Health Agency (DHA) directives

• Adhere to URAC standards, state and federal regulations and individual licensing boards

• Participate in professional development activities to include current principles, procedures, and knowledge domains of case management based on nationally recognized standards and licensure requirements

• Attend and participate in Care Management quality management/performance improvement activities

• Performs all duties within the scope of her/his licensure and other tasks as assigned

Required Qualifications

• Active Registered Nurse (RN) license in state of employment

• An active designation as a Certified Care Manager (CCM)

• 3 or more years clinical nursing experience or managed care experience

• Proficient with Microsoft Office Excel & Word

• Excellent communication skills, verbal and written

• Ability to work an 8-hour shift between the hours of 8 a.m.-5 p.m. (In your respective time zone)

• Excellent organizational skills

• Ability to handle calls and member contacts in a polite and professional manner

• Ability to handle multiple tasks simultaneously and to prioritize appropriately

• Our Department of Defense Contract requires U.S. citizenship for this position

• Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation)

Work at Home Requirements
To ensure Hybrid Office/Home associates’ ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Bilingual — English, Spanish

• Bachelor’s degree in nursing or health related field

• Certified Diabetes or Asthma Educator

• Experience with Case/Disease management programs

• Experience with motivational interviewing techniques

• Direct or Indirect Military or Tricare experience a plus

Additional Information

Work Style: Remote
Work Days/Hours: Monday – Friday; must be able to work an 8 hour shift between 8:00 a.m. – 5 p.m.

Social Security Task:
Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

Interview format:
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

This is a remote position
#LI-Remote

Scheduled Weekly Hours

40