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Care Manager - Telephonic Physical Health

Humana

Humana

Customer Service
Remote
Posted on Wednesday, October 11, 2023

Description

Why Humana?

At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we’ve got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future.

Fostering a culture of inclusion is part of the fabric of who we are. We must have a workplace that reflects the people we serve and thrives in part because every person can bring their whole self to work to do their best work. Our vibrant, diverse culture and environment of inclusion is one of our greatest strengths.

About Humana Healthy Horizons

Humana Healthy Horizons is more than a health plan. We’re human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health.
Responsibilities

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The individual in this role will work as an Oklahoma-based, primarily telephonic care manager, assessing and evaluating enrollees’ needs and requirements to achieve or maintain optimal wellness by guiding enrollees/families towards and facilitating interaction with appropriate resources for their care and wellbeing. The individual in this role will work in collaboration with the interdisciplinary care management team. This team includes community health workers, housing support specialists, SDOH coordinators, and care management support assistants. The Care Manager, Telephonic Physical Health Nurse 2 work assignments are varied but will focus on those enrollees with primarily physical health needs. The Care Manager, Telephonic Physical Health Nurse 2 will utilize clinical expertise and experience to determine when face-to-face enrollee support is required, engaging the appropriate members of the care management team and/or coordinating in-person meetings between the care manager and the enrollee. This team-based approach is designed to ensure enrollees receive holistic person-centered care. Work assignments for this role are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Responsibilities:

  • Employs a variety of strategies, approaches, and techniques to manage an Enrollee’s behavioral, physical, environmental, and psycho-social health needs.

  • Ensures Enrollees are progressing toward desired outcomes by continuously monitoring their assessments and evaluations.

  • Identifies and resolves barriers that hinder effective care and ensures through continuous monitoring of assessments and evaluations that the Enrollee is progressing toward desired outcomes.

  • May create Enrollee care plans, and understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

  • Makes decisions about their own work methods, occasionally in ambiguous situations, and requires minimal direction, receiving guidance where needed.

  • Follows established guidelines/procedures.

  • Performs telephonic and face to face assessments and evaluations of the member’s needs and requirements to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member.

  • Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.

  • Creates member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

  • Collaborates with providers and community services to promote quality and cost-effective outcomes.

REQUIRED QUALIFICATIONS:

  • Active Registered Nurse (RN) license, or a Licensed Master Level Social Worker ((LCSW, LMSW, LMSW-ACP, CSW, LPC, LMFT, LPAT)
  • Minimum 1-year clinical experience
  • 2 or more years of experience of in-home case or care management
  • Exceptional communication and interpersonal skills with the ability to quickly build rapport.
  • Knowledge of community health and social service agencies and additional community resources.
  • Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
  • Experience working with Medicaid and/or Medicare Enrollees to coordinate services, care needs, or benefits.
  • This role is considered member facing and is part of Humana Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  • Must reside in Oklahoma

PREFERRED QUALIFICATIONS:

  • Case Management Certification (CCM)

ADDITIONAL INFORMATION

  • Workstyle: This is a remote position

Our Benefits

Health benefits effective day 1. Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

  • Paid time off, holidays, volunteer time and jury duty pay, Recognition pay.
  • 401(k) retirement savings plan with employer match.
  • Tuition assistance, Scholarships for eligible dependents.
  • Parental and caregiver leave.
  • Employee charity matching program.
  • Network Resource Groups (NRGs).
  • Career development opportunities.

Work at Home Criteria

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 recommended; wireless, wired cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if approved by leadership.
  • Employees 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 employees 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.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$69,800 - $87,000

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Scheduled Weekly Hours

40