Become a part of our caring community and help us put health first

The Telephonic Nurse Case Manager will be a member of the Case Management Team, providing a comprehensive, holistic approach for case management throughout the continuum of care. The case manager will offer guidance. support, and coordination of the beneficiary’s care as directed by the beneficiary, the provider(s) or other members of the healthcare team and within the scope of the case manager’s licensure. The case manager will assess, plan, coordinate, implement, monitor, and evaluate the medical services required to meet the complex health needs of TRICARE beneficiaries, to maximize each beneficiary’s capacity for self-care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care. The case manager will collect and document data to facilitate measurement of case management involvement. The case manager will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical and behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in addition to MTF UM / CM staff, physicians and providers as necessary; organize, arrange and coordinate services necessary to address the beneficiary’s condition. In their role, the Case Manager will collaborate with other care management programs until the beneficiary’s needs are met and case closure or graduation is achieved. Performs all duties within the scope of licensure.

Role responsibilities:
35% Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the Case Management purview across the continuum of care. Develop a cost effective treatment plan that is acceptable to both the beneficiary (patient) and other members of the care team utilizing both evidence based medical information, DoD and community resources (SDOH). Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care. Maintain beneficiary’s privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process. 

30% Utilize applicable sources of information to identify, assess, and enroll patients requiring case management. 

25% Coordinate and collaborate with other members of the care management team or external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the case management team.

10% Support the Care Coordinators with the coordination of care for beneficiaries not under case management as needed.

Use your skills to make an impact

Required Qualifications

• Our Department of Defense Contract requires U.S. citizenship for this position

• Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

• A current, valid and unrestricted license as a Registered Nurse (R.N.)

• Minimum Associate’s degree in Nursing

• 2 years case management experience

• An active designation as a Certified Care Manager (CCM). If no active designation as a CCM at hire date, this must be obtained within the first year of hire.

• 3 or more years of clinical nursing or managed care experience

• Behavioral Health Experience 

• Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook

Preferred Qualifications

• Bachelor’s or Master’s degree in Nursing

• Prior/current experience in Utilization Management/Utilization Review with MCG

• Direct or Indirect Military experience a plus

• Bilingual fluent in Spanish, English

• Experience with motivational interviewing techniques

Work at Home/Remote Requirements

• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense

• 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

Additional Information

Work Days/Hours: Monday – Friday; must be able to work an 8 hour shift sometime between the hours of 8 a.m. – 6 p.m. EST.

Training/Training Hours: Mandatory for the first 4 weeks; 8:00 a.m. – 5:00 p.m. EST

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 yearThis 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 usHumana 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 because he or she is a protected veteran. 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.