RN Field Care Manager – Medicaid HCBS/LTSS
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Job Description
Humana RN coordinating Medicaid and Medicare members’ home-based care in Wayne and Macomb Counties. Conducting assessments, care planning, and LTSS/HCBS compliance activities.
Responsibilities:
- Assess members’ needs and help members and families access appropriate resources to achieve or maintain optimal health and well-being
- Use strategies to address members’ physical, environmental, and psychosocial health needs
- Manage a caseload and complete member assessments in home, community-based, and telephonic settings
- Provide clinical support and guidance, particularly for members with complex medical needs
- Develop and coordinate care plans to ensure appropriate services
- Address barriers to healthcare and advocate for optimal member outcomes
- Review, evaluate, and complete medical complexity attestations and clinical oversight activities
- Assess care needs to ensure services are provided in the least restrictive setting
- Develop and update Individual Care Plans with care team members, informal caregivers, coaches, and primary care providers
- Help members and caregivers access social, housing, educational, and other services
- Serve as primary contact for the Interdisciplinary Care Team (ICT)
- Coordinate with members, ICT participants, and external resources
- Conduct comprehensive InterRAI Integrated Health Care (IHC) assessments
- Conduct Nursing Facility Level of Care Determinations (NFLOCDs)
- Support accurate eligibility decisions and person-centered care planning
- Ensure compliance with state Medicaid, LTSS, HCBS waiver, and regulatory requirements
- Travel 75%–90% within Wayne and/or Macomb Counties for in-home visits
Requirements:
- Must reside in Michigan, specifically Wayne or Macomb Counties
- Active Michigan license as a Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN), including Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS), with no disciplinary actions
- Experience with Home and Community-Based Services (HCBS) and waiver programs
- 2+ years of experience in healthcare and/or case management
- Experience conducting Long-Term Services and Supports (LTSS) assessments
- Experience working with Medicaid regulations
- Experience applying person-centered planning principles
- Experience collaborating with interdisciplinary teams, providers, members, and caregivers to complete comprehensive assessments and recommend appropriate services
- Ability to maintain timely, accurate, and compliant documentation in accordance with organizational, state, and federal requirements
- Knowledge of community health, social service agencies, and community resources
- Ability to use electronic information systems and software programs, including electronic medical records (EMRs)
- Excellent keyboarding and web navigation skills
- Intermediate to advanced computer skills, including Microsoft Word, Outlook, and Excel
- Valid state driver’s license and personal vehicle liability insurance
- Must complete TB screening
- Bachelor of Science in Nursing (BSN) preferred
- Experience completing InterRAI Integrated Health Care (IHC) assessments preferred
- Experience conducting and documenting Nursing Facility Level of Care Determinations (NFLOCDs) preferred
- Experience in health promotion, coaching, and wellness preferred
- Previous experience in managed care 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
- Mileage reimbursement for eligible travel
- Self-provided internet requirements for home or hybrid home/office employees
- Occasional travel to Humana offices for training or meetings
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