Humana Care Manager, Telephonic Nurse 2 in Springfield, Missouri
The Telephonic Care Manager will be part of the Humana Military Care Management team; providing a comprehensive, holistic approach for Disease Management and Personal Nurse programs throughout the continuum of care. They will have personal interaction with beneficiaries to address clinical conditions identified through Predictive Analytics helping them develop healthy behaviors, understand their condition/disease, coping skills and treatment plan adherence; leading to decreased risk of progression into a disease and symptoms and complications of the condition/disease. The care manager will assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary required to meet the health needs of TRICARE beneficiaries, to maximize each beneficiary's capacity for self-care to enhance quality of medical care and achieve desired clinical outcomes.
As part of the Care Management Team, the care manager will serve as the primary coordinator and point of contact for the beneficiary for all activities within the clinical spectrum. This will include coordination and collaboration within the Care Management programs, Military Treatment Facility (MTF) UM/CM/DM staff, physicians or providers to ensure there is a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the Care Management program. Performs all duties within the scope of his/her licensure.
Provide telephonic care guidance support to beneficiaries and their family/caregiver to ensure education, care coordination and support measures are in place; according to the established plan of care.
Assess beneficiary needs and develop a personalized plan of care from the assessment findings; in coordination with the beneficiaries' physician.
Conduct assessments to identify gaps in care, eligibility for assistance and/or need for care management program or other referral services in collaboration with Humana Government Business.
Utilize Motivational Interviewing and solution-oriented approaches in communication delivery.
Identify Social Determinants of Health needs and/or community resources to provide services
Maintain beneficiary's privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.
Ensure adherence to policies and performance standards in accordance with the URAC, TRICARE Operations Manual (TOM), TRICARE Provider Manual (TPM) or any other Defense Health Agency (DHA) directives.
Adhere to URAC standards, state and federal regulations and individual licensing boards.
Participate in professional development activities to include current principles, procedures, and knowledge domains of case management based on nationally recognized standards and licensure requirements.
Attend and participate in Care Management quality management/performance improvement activities.
Performs all duties within the scope of her/his licensure and other tasks as assigned.
Our Department of Defense Contract requires U.S. citizenship for this position.
Active RN license in state of employment
Case Management Certification (CCM)
3-5 plus years clinical or managed care experience
Proficient with Microsoft Office Excel & Word
Excellent communication skills, verbal and written
Excellent organizational skills
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)
Work at Home Requirements
Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work
Must provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
Bilingual - English, Spanish
Bachelor's degree in nursing or health related field
Certified Diabetes or Asthma Educator
Experience with Case/Disease management programs
Experience with motivational interviewing techniques
Direct or Indirect Military experience a plus
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 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