Humana
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.
This is a remote, telephonic position, but you must live in Puerto Rico. The RN Care Manager uses clinical knowledge to assess and evaluate members' needs to achieve and maintain optimal wellness. They also guide members with chronic conditions toward and facilitate interaction with resources appropriate for their care and wellbeing. The Care Manager reports to a Manager of Care Management, and work assignments frequently require interpretation and independent determination of the appropriate courses of action. We require you to be bilingual in English/Spanish and will test you for both languages - Speaking/Reading/Writing included. Please submit your resume in English.
Required Qualifications: Bachelor's Degree in Nursing (BSN) Bilingual in English and Spanish (and able to pass language proficiency tests in both languages) Active RN license without restrictions in Puerto Rico Active RN license without restrictions in Florida Affiliated with the CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico). Prior clinical experience in adult acute care, skilled nursing, rehabilitation or discharge planning Knowledge in Chronic Condition management (treatment, pharmacological treatment, signs and symptoms), including Diabetes, Hypertension, COPD, and chronic kidney disease. Shift is 8-hours, plus 1 hour for lunch, from 8:30 AM to 5:30 PM EST and we adjust for Daylight Savings. We adjust the work schedule according to business needs including necessary overtime and weekends. Preferred Qualifications: Health Plan experience Previous Case Management Experience Call center or triage experience Previous experience managing Medicare members Work-At-Home Requirements To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can only be used if leadership approves it. Humana will provide Work-At-Home employees with telephone equipment appropriate to meet the requirements for their position. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Language Proficiency Testing Any Humana associate who speaks with a member in a language other than Spanish must take a language proficiency assessment, provided by an outside vendor, to ensure competency. The Federal Government requires applicants to take the Interagency Language Rating (ILR) test.
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The Care Manager, Telephonic Nurse employs a variety of strategies and techniques to manage a member's physical, environmental and psycho-social health issues. Responsibilities include the following: Resolve barriers that hinder care. Assess members with chronic conditions to determine their state of wellness and determine next steps, if any. Ensure patient is progressing towards desired outcomes by managing patient care through assessments and evaluations. May create member care plans. Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Require minimal direction and receive guidance where needed. Follow established guidelines/procedures.
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