The Field Care Manager Nurse 2 (Care Manager Plus, Physical Health) work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Additional responsibilities for the PH CM are further defined by these two separate roles:
The PH CM must perform the full scope of care coordination activities and responsibilities for members who need care coordination and are not assigned to a Care Coordination Entity (i.e. the Ohio RISE Plan, and/or a CME, or who choose to receive their care management from the MCO). Care Manager serves as the single point of contact for care coordination.
The PH CM Plus must ensure the completion of the full scope of care coordination activities and responsibilities for members who need care coordination and are assigned to a Care Coordination Entity (i.e. the Ohio RISE Plan, CPCs, and/or a CMEs). Care Manager Plus serves as the single point of contact for care coordination.
Ensuring the member receives the full scope of care coordination services, including comprehensive assessment completion (inclusive of the HRA), person-centered care plan completion, ensuring no duplication with the CCEs (Ohio RISE Plan, and/or CME), and identifying and addressing ongoing needs.
Providing actionable data, information, and support to assist the CCE, Ohio RISE Plan, and/or CME in meeting the member’s care needs.
Integrating information collected by the CCE into its Care Coordination Portal to minimize duplication.
The Field Care Manager Plus employs a variety of strategies, approaches and techniques to manage a member’s physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care.
Utilize a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs.
Performs telephonic and face to face assessments and evaluations of the member’s needs 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.
Perform clinical intervention through the development of a care plan specific to each member based on clinical judgement, changes in members’ health or psychosocial wellness, and identified triggers
Collaborates with providers and community services to promote quality and cost-effective outcomes.
Coordinates delivery of needed services/supports for Physical Health, Social Determinant of Health and value added benefits.
Coordinates across the transdisciplinary care team (at a minimum the PCP) and transitions of care
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Submits incident reports
Licensed Registered Nurse (RN) in the state of Ohio without restrictions
Minimum one (2) years of clinical experience
Intermediate to advanced computer skills and experience with Microsoft Word, Outlook, and Excel; excellent keyboard and web navigation skills
Exceptional communication and interpersonal skills with the ability to quickly build rapport
Ability to work with minimal supervision within the role and scope
Complete education and self-development activities per Humana Healthy Horizons and departmental requirements
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Workstyle: Combination remote work at home and onsite member visits
Location: Must reside in Ohio
Hours: Must beable to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM Eastern Time, over-time may be requested to meet business needs.
Travel: Must be willing to commute about 50% to meet with members.
Remote Work at Home Requirements:
Must have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you work
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana At Home systems if 25Mx10M
Driver’s License, Transportation, Insurance This role is a part of Humana’s Driver Safety program and therefore requires and individual to have
a valid state driver’s license
proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits,
and access to a reliable vehicle
Tuberculosis (TB) screening program
This role is considered patient facing and is part of Humana At Home’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Case Management Certification (CCM)
Experience working with Medicare, Medicaid and dual-eligible populations
Field Case Management Experience
Health Plan experience
Knowledge of community health and social service agencies and additional community resources
Experience with health promotion, coaching and wellness
Bilingual (Spanish, Somali or other)
As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Covid Compliance Policy
For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster or commit to testing protocols
Provide proof of applicable exemption including any required supporting documentation
Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours