Bilingual Care Manager, Telephonic RN

Puerto Rico

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must be fully bilingual in English and Spanish, passing a speaking, reading, and writing test. A Bachelor's Degree in Nursing (BSN) and an active, unrestricted RN license in Puerto Rico are required. An active RN license in Florida or having passed the NCLEX exam is also necessary, along with affiliation with the CPEPR. Prior clinical experience in adult acute care, skilled nursing, rehabilitation, or discharge planning is essential. The ability to work independently and as part of a team is crucial. Preferred qualifications include health plan experience, previous case management, call center or triage experience, and prior experience managing Medicare members. For remote work, a minimum internet download speed of 25 Mbps and upload speed of 10 Mbps is required, along with a dedicated, interruption-free workspace.

Responsibilities

The Care Manager, Telephonic Nurse will assess and evaluate members' needs and requirements to achieve optimal wellness, guiding members with chronic conditions toward appropriate resources. Responsibilities include identifying and resolving barriers to effective care, continuously monitoring patient progress through assessments and evaluations, and potentially creating member care plans. They must understand department and organizational strategies and make decisions regarding their work methods, often in ambiguous situations, following established guidelines.

Skills

Nursing

Bilingual (English/Spanish)

Telephonic Care Management

Chronic Condition Management

Patient Assessment

Care Planning

RN License (Puerto Rico)

RN License (Florida) or NCLEX

Communication

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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