RN Telephonic Transplant Care Manager-WAH

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Job Information

Humana

RN Telephonic Transplant Care Manager-WAH

in

Pittsburgh

Pennsylvania

Description

The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Location:

work at home, must hold a Compact license in a compact state

The Transplant Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage the transplant member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. In this role you will:

Act as the member and provider single point of contact for all transplant, ventricular access device (VAD), and chimeric antigen receptor T cell (CAR-T) therapy services

Guide members by providing information and resources that enable the member to make informed decisions

Educate the member on their benefits, and guide the member to maximize their benefit

Discussion of benefits to help guide members to participating Transplant centers and benefit maximization

Work tasks assigned in the clinical documentation system

Work assigned UM and CM cases within compliance timelines

Build and update UM & CM cases as appropriate

Arrange for transfers to alternative levels of care using clinical knowledge and benefit plan design and identify potentially unnecessary services and care delivery settings and recommend alternatives, if appropriate by analyzing clinical protocols

Complete Inpatient reviews as appropriate

Collaborate with Transplant Medical Directors as appropriate

Identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria/guidelines

Discharge planning, as appropriate and complete Post discharge calls and follow up calls, as appropriate

Hours are 8:30- 5 p.m. EST for this role

Required Qualifications

Licensed Registered Nurse (RN) in appropriate state with no disciplinary action.

Compact state license: must reside in a compact state with the ability to obtain multiple state licenses without restrictions

5 or more years of clinical nursing

3 years of critical care experience, i.e.: ICU, step down, ER, LTAC, etc.

Proficient with various EMRs

Microsoft Office applications including Word & Excel

Must have a separate room for privacy with a locked door during working hours and during communication with members.

We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html#vaccinated) for this job as we are a  healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.

If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law.

Must provide hardwired high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service are prohibited). A minimum standard speed of10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Must be able to work 8:30-5:00 PM Eastern hours

Ability to travel less than 10% annually once travel restrictions are lifted

Preferred Qualifications

BSN degree

Experience working in Utilization Management within last 2 years

Experience with case management, discharge planning and patient education for adult acute care

Knowledge of Milliman or Interqual

Managed care experience

Certified Case Manager (CCM)

Additional Information

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

Company info

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