The Registered Nurse Care Manager (Care Manager, Telephonic Nurse 2) performs telephonic and face-to-face assessments and evaluations of Moderate to High acuity member's needs and requirements to achieve and/or maintain optimal wellness by guiding members/families toward and facilitate interaction with resources appropriate for the care and well-being of members and their families/caregivers across the lifespan. The Care Manager supports individuals with acute, chronic, complex, behavioral health, and special healthcare needs to promote optimal health outcomes and quality of life. The CM RN utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical and behavioral healthcare through care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. The Care Manager's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Position Responsibilities:

• Coordinates care for members with acute, chronic, complex, behavioral health, and medically fragile conditions to ensure appropriate access to services and optimal health outcomes.
• Responsible for telephonic and/or face-to-face assessment, planning, implementation, and coordination of care management activities for members across the lifespan, ensuring medical, behavioral health, functional, and psychosocial needs are addressed through collaboration with members, caregivers, providers, and community resources.
• Identifies and resolves barriers that hinder effective care. Ensure patients are progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations.
• Responsible for health risk assessments along the continuum of care for members
• Using a holistic approach, consults with manager, medical directors, and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives.
• Candidate will assess the members, create individualized care plans, and attend interdisciplinary care team meetings.
• Works collaboratively with the members' interdisciplinary care team.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Collaboration with internal and external providers or departments to meet the members' needs
• Meet requirements for contractual and regulatory compliance
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

Required Qualifications

• Must reside in Illinois or a border state within a commutable distance of IL.
• Minimum Associates nursing degree required
• 3+ years of experience, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
• 2+ years of experience of care management
• At least one year of acute care clinical experience is required. This experience can be in a hospital, emergency department, home health, rehabilitation, ambulatory care, skilled nursing, behavioral health, case management, disease management, utilization management, or clinical triage setting.
• Knowledge of community health and social service agencies and additional community resources
• Ability to use a variety of electronic information applications/software programs including electronic medical records
• Excellent keyboard and web navigation skills
• Willing and able to travel up to 25% of their time

Preferred Qualifications

• Bachelor's of Science in Nursing (BSN)
• 3+ years of in-home assessment and care coordination experience
• Experience with health promotion, coaching and wellness
• Previous managed care experience
• Bilingual preferred (Spanish, Arabic, Vietnamese or other)
• Certification in Case Management
• Motivational Interviewing Certification and/or knowledge
• Experience working with diverse populations across the lifespan.
• Experience managing members with chronic and complex medical conditions.
• Certified Case Manager (CCM), Accredited Case Manager (ACM), or related certification preferred.

Additional Information

• Workstyle: This is a remote position that requires travel.
• Travel: Up to 25% field-based interactions meeting with members and/or their families, community partners and other care teams. May need to attend occasional onsite meetings in Humana's Illinois locations.
• Typical Workdays and Hours: Monday - Friday 8:00 AM - 5:00 PM CST. May need to be provide flexibility with work schedule based on business needs.
• Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher. 

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Description of Benefits