Care Manager, Telephonic Nurse

Become a part of our caring community

As a remote Telephonic Care Manager you will report to a Manager of Care Management. You will be providing a comprehensive, holistic approach for Case Management (CM) Special Populations program throughout the continuum of care. You will provide case management specialized interventions by leveraging the most appropriate care sites and levels of care to prevent or decrease hospital readmissions, promoting appropriate utilization of alternative sources of available funding, enhancing coordination of care, and reducing fragmentation of clinical services.
You will serve as the point of contact in the Special Populations Program for the beneficiary for all activities within the clinical spectrum. You will coordinate and collaborate within the Care Management programs, Military Treatment Facility (MTF) Utilization Management/Case Management/CM staff, physicians or providers to ensure there is a fully integrated care plan addressing all beneficiary needs and conditions.

Use your skills to make an impact

Required Qualifications

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

- Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)

- HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.

- Active RN license in state of employment

- Ability to obtain CCM certification within 1 year of hire

- 2 years case management experience

- 3 years clinical RN or managed care RN experience

Preferred Qualifications

- Bachelor's degree in nursing

- TRICARE experience

- Experience with MCG

- Current CCM

Additional Information

Work Style : Remote Work Schedule : Monday – Friday; must be able to work an 8-hour shift between the hours of 8:00 a.m. – 6 p.m. EST (Eastern Standard Time)

Training/Training Hours : Mandatory for the first 4 weeks between the hours 8:00 a.m. – 5:00 p.m. EST (Eastern Standard Time)
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.

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Humana will provide Home or Hybrid Home/Office associates with telephone 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

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana 's offices for training or meetings may be required. Scheduled Weekly Hours
40 Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay