Become a part of our caring community and help us put health first
Humana Healthy Horizons in Ohio is seeking a RN Field Care Manager 2 with Maternity, L&D, Mother Baby expertise. They will assess and evaluate member's needs to achieve and/or maintain optimal wellness. The Field Care Manager will connect members/families with resources appropriate for their care and wellbeing.
The RN, Field Care Manager Nurse 2 works in a CM OR CM Plus capacity based on member’s needs. Assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities CM:
- Performs 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).
- Serves as the single point of contact for care coordination.
Responsibilities CM Plus:
- Ensures 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).
- Serves as the single point of contact for care coordination.
- Ensures 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.
- Provides actionable data, information, and support to assist the CCE, Ohio RISE Plan, and/or CME in meeting the member's care needs.
- Integrates information collected by the CCE into its Care Coordination Portal to minimize duplication.
Additional Responsibilities:
- 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.
- Utilizes 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.
Use your skills to make an impact
Required Qualifications
- Must reside in the state of Ohio.
- Registered Nurse (RN) in the state of Ohio without restrictions.
- Minimum two (2) years of clinical experience (including Maternity, Labor & Delivery, Mother Baby.)
- 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.
- This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
- This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
- Must have the ability to provide a high speed DSL or cable modem for a home office.
- A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
- Satellite and Wireless Internet service is NOT allowed for this role.
- A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
- Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Preferred Qualifications
- Case Management Certification (CCM).
- Experience working with Medicare, Medicaid or 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).
Additional Information
- Workstyle: A combination of working remotely and field-based member visits.
- Travel: Up to 50% to meet with members/families.
- Workdays & Hours: 40 hour work week, Monday through Friday; 8:00 AM to 5:00 PM Eastern Standard Time(EST), over-time may be requested to meet business needs.
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Interview Format
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 or computer 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
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$69,800 - $96,200 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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