Care Manager, Telephonic Nurse

Position Overview

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

Responsibilities

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. Responsibilities include the following:

• 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.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

Use your skills to make an impact.

Required Qualifications

• Bachelor's Degree in Nursing (BSN)
• Active RN license without restrictions in Puerto Rico
• Active RN license without restrictions in Florida - if you DO NOT have an active FL RN license, you must have already passed the NCLEX exam.
• 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
• 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

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 be used only if approved by leadership.
• Humana will provide Work-At-Home employees with telephone equipment appropriate to meet the business requirements for their position/job.
• 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. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices...