Care Manager, Telephonic Registered Nurse
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Job Description
Telephonic RN care manager supporting Humana Medicare members with chronic conditions and transitional care needs. Coordinating personalized care plans, resources, and interventions to improve outcomes and independence.
Responsibilities:
- Telephonically support Medicare members with transitional care needs and complex chronic conditions
- Assess members’ physical, environmental, behavioral, and psychosocial health needs
- Continuously assess member progress and adjust care interventions
- Develop, implement, and monitor individualized care plans
- Connect members and families with healthcare, community, and social service resources
- Coordinate care and collaborate with interdisciplinary teams
- Apply clinical strategies and interventions to manage member health concerns
- Evaluate risk factors and implement interventions to prevent avoidable hospitalizations and emergency department utilization
- Identify and address social, financial, environmental, and functional barriers to care
- Exercise clinical judgment and independent decision-making in a fast-paced care management environment
- Engage members telephonically through an auto-dialer environment
- Meet established quality, productivity, and member outcome goals
- Occasionally travel to Humana offices for training or meetings
Requirements:
- Active, unrestricted Registered Nurse (RN) license in state of residence
- Active Compact (Multistate) licensure with no disciplinary action
- Three (3) or more years of clinical acute care experience, including case management, discharge planning, and patient education for adult populations
- Clinical expertise managing chronic conditions through assessment, care coordination, clinical intervention, and individualized care planning
- Strong clinical assessment, critical thinking, and decision-making skills
- Proficiency with Microsoft Office (Word, Excel, Outlook)
- Ability to navigate multiple systems and applications simultaneously, including dual-monitor environments
- Ability to manage multiple priorities in a fast-paced, telephonic care management environment
- Advanced verbal and written communication skills for telephonic and virtual interactions
- Dedicated home office workspace
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Ability to protect member PHI / HIPAA information in a dedicated workspace
- BSN or MSN degree (preferred)
- Managed care experience (preferred)
- Certified Case Manager (CCM) (preferred)
- Bilingual English and Spanish ability (preferred)
Benefits:
- Bonus incentive plan based on company and/or individual performance
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Dedicated remote work-at-home arrangement
- Training and onboarding program
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