Care Manager, Telephonic Nurse
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Job Description
Telephonic Care Manager guiding patients through CenterWell Home Health’s home health, hospice, and palliative care services. Coordinating clinical eligibility, referrals, admissions, and patient follow-up.
Responsibilities:
- Ensure optimal continuity of care for patients transitioning into and out of services
- Serve as a CenterWell Home Health representative for discharged patients and patients needing post-acute services
- Navigate healthcare options, post-acute care services, Medicare coverage, billing issues, and healthcare resources
- Provide patient options and education regarding sites of service, specialty offerings, post-acute care, and related questions
- Handle customer issues including location lookup, directions, and complaints
- Determine clinical level of care using discussions, medical records, and other clinical data
- Match patient needs to service locations or provide alternative services
- Advocate for customers throughout the referral process
- Follow up and track referral and admission outcomes
- Support department performance objectives and patient satisfaction goals
- Assist with admissions by serving as a patient ambassador
- Provide education regarding Home Health, Hospice, and Palliative Care Services
- Help with clinical eligibility review for alternate services
- Participate in mandatory HIPAA, Business Ethics and Compliance, and company policy training
- Participate in special projects and perform other assigned responsibilities
- Report directly to the Manager, Care Management
Requirements:
- Associates Degree required; BSN preferred
- Current compact state RN license required
- Business needs may require additional state licensures
- At least 3 years post-acute nursing experience
- Knowledge of home health, hospice, and palliative care services
- Ability to learn and master information related to client locations and services
- Analytical and problem-solving skills
- Excellent verbal and interpersonal skills
- Ability to communicate with empathy over the phone
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Dedicated work space without ongoing interruptions to protect member PHI/HIPAA information
- Availability for Monday-Friday 9am-5:30pm EST, every third weekend, rotating holidays, and training outside the advertised shift when needed
Benefits:
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Work-from-home arrangement
- Occasional travel to Humana offices for training or meetings
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