Telephonic Nurse Care Manager

Profile

Description

Responsibilities

The Telephonic Nurse Case Manager will be a member of the Case Management Team, providing a comprehensive, holistic approach for case management throughout the continuum of care. The case manager will offer guidance. support, and coordination of the beneficiary's care as directed by the beneficiary, the provider(s) or other members of the healthcare team and within the scope of the case manager's licensure. The case manager will assess, plan, coordinate, implement, monitor, and evaluate the medical services required to meet the complex health needs of TRICARE beneficiaries, to maximize each beneficiary's capacity for self-care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care. The case manager will collect and document data to facilitate measurement of case management involvement. The case manager will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical and behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in addition to MTF UM / CM staff, physicians and providers as necessary; organize, arrange and coordinate services necessary to address the beneficiary's condition. In their role, the Case Manager will collaborate with other care management programs until the beneficiary's needs are met and case closure or graduation is achieved. Performs all duties within the scope of his/her licensure.

Role responsibilities :

35% Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the Case Management purview across the continuum of care. Develop a cost effective treatment plan that is acceptable to both the beneficiary (patient) and other members of the care team utilizing both evidence based medical information, DoD and community resources (SDOH). Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care. Maintain beneficiary's privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.

30% Utilize applicable sources of information to identify, assess, and enroll patients requiring case management.

25% Coordinate and collaborate with other members of the care management team or external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the case management team.

10% Support the Care Coordinators with the coordination of care for beneficiaries not under case management as needed.

OUR DEPARTMENT of DEFENSE Contract Requires U.S. citizenship for this position .

Required Qualifications

A current, valid and unrestricted license as a Registered Nurse (R.N.)

Minimum Associate's degree in Nursing

Two (2) plus years case management experience

An active designation as a Certified Care Manager (CCM)

3 or more years of clinical nursing or managed care experience (Highly preferred in Maternity)

Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook.

Excellent written and verbal communication skills.

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 Processing).

Work at Home/Remote Requirements

WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

Bachelor's or Master's degree in Nursing

Prior/current experience in Utilization Management/Utilization Review with MCG

Experience with Medical/Behavioral Health Case Management Programs

Behavioral Health Experience

Direct or Indirect Military experience a plus.

Bilingual fluent in Spanish, English

Experience with motivational interviewing techniques

Additional Information

Work Days/Hours : Monday - Friday; must be able to work an 8 hour shift sometime between the hours of 7:30 a.m. - 6 p.m. EST.

Training/Training Hours : Mandatory for the first 4 weeks; 8:00 a.m. - 5:00 p.m. EST

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.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com