Humana
Humana Inc. (NYSE: HUM) is committed to putting health first ā 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 ā 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.
This is a Work-At-Home position located in Puerto Rico. You must live in Puerto Rico for this position. The Care Manager, Telephonic Nurse works in a telephonic environment. They assess and evaluate members' needs and requirements to achieve and maintain an optimal wellness state. Using clinical knowledge, the Care Manager guides members with chronic conditions toward and facilitates interaction with resources appropriate for their care and wellbeing. The Care Manager, Telephonic Nurse's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. You must be fully bilingual in English/Spanish and will be required to pass a test for both languages - Speaking/Reading/Writing included. ***Please submit resume in English. The Care Manager, Telephonic Nurse employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues.
Required Qualifications: Active RN license without restrictions in Puerto Rico Active RN license without restrictions in Florida Affiliated with the CPEPR (Colegio de Profesionales de EnfermerĆa de Puerto Rico). Prior clinical experience in adult acute care, skilled nursing, rehabilitation, OR discharge planning. Ability to work independently under minimum supervision and with a team. Able to work an 8-hour shift between 8:30 AM - 5:30 PM EST and adjusted for Daylight Savings (Work schedule can be adjusted according to business hours - necessary overtime and/or weekends) Preferred Qualifications: Health Plan experience Previous Case Management Experience Call center or triage experience Previous experience managing Medicare members.
Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. āMakes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
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