RN, Care Manager, Telephonic Nurse

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.

Humana Gold Plus Integrated is seeking a RN, Care Manager, Telephonic Nurse 2 who will assess and evaluate member’s needs with emphasis on discharge planning on preventing rehospitalization, monitoring, and managing chronic conditions effectively, in a telephonic environment. This position supports members in addressing their health care needs by helping them access appropriate services, skills, and support needed to achieve optimal health and life functioning independence in the community. The RN, Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Strengthens care management activities and supports improving members well-being, reducing unnecessary healthcare costs and enhancing healthcare delivery. Assesses, monitors, and evaluates members’ chronic condition as well as provide and document meaningful interventions and outcomes. Provides episodic care coordination focusing on education and support to enhance lifestyle modifications and self-management techniques. Collaborate with Care Coordinators and other identified care team members as needed along with utilization management (UM) staff, physicians and providers as necessary and arrange services necessary to address the member’s condition and current needs. May contribute to interdisciplinary care planning and meetings. Meet requirements for contractual and regulatory compliance. Makes decisions regarding your own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Follows established guidelines/procedures. Other duties as required.