[Remote] Bilingual RN- Work at home at Humana

Puerto Rico

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Must live in Puerto Rico
Bachelor's Degree in Nursing (BSN)
Fully bilingual in English and Spanish (must pass language proficiency tests in speaking, reading, and writing)
Active RN license without restrictions in Puerto Rico
Active RN license without restrictions in Florida (or have already passed the NCLEX exam if not active)
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 (e.g., Diabetes, Hypertension, COPD, Chronic Kidney Disease, including treatment, pharmacological treatment, signs & symptoms)
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 (adjusted for Daylight Savings; may include overtime and/or weekends)
Work-at-home setup with minimum internet speed: 25 Mbps download, 10 Mbps upload (wireless, wired cable, or DSL suggested; satellite/cellular/microwave only if approved)
Dedicated work space lacking ongoing interruptions to protect PHI/HIPAA information

Responsibilities

Assess and evaluate members' needs and requirements to achieve and maintain an optimal wellness state
Use clinical knowledge to guide members with chronic conditions and facilitate interaction with appropriate resources for their care and wellbeing
Employ a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues
Identify and resolve barriers that hinder effective care
Ensure patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations
May create member care plans
Understand department, segment, and organizational strategy and operating objectives, including linkages to related areas
Make decisions regarding own work methods, occasionally in ambiguous situations, with minimal direction and following established guidelines/procedures

Skills

Key technologies and capabilities for this role

BSNRN LicenseBilingual English SpanishTelephonic NursingCare ManagementPatient AssessmentCare PlanningChronic Disease Management

Questions & Answers

Common questions about this position

Is this a remote position and where must I live?

This is a Work-At-Home position located in Puerto Rico, and you must live in Puerto Rico for this role.

What are the required qualifications for this RN Care Manager role?

Required qualifications include a Bachelor's Degree in Nursing (BSN), bilingual proficiency in English and Spanish with passing language tests, active RN licenses without restrictions in Puerto Rico and Florida (or passed NCLEX), affiliation with CPEPR, prior clinical experience in adult acute care or similar, knowledge in chronic condition management, and ability to work independently and with a team.

What is the work schedule for this position?

You must be able to work an 8-hour shift between 8:30 AM - 5:30 PM EST, adjusted for Daylight Savings, with possible adjustments according to business hours including necessary overtime and/or weekends.

What language skills are required?

You must be fully bilingual in English/Spanish and pass a test for both languages including speaking, reading, and writing. Please submit your resume in English.

What preferred qualifications would make me a stronger candidate?

Preferred qualifications include health plan experience, previous case management experience, call center or triage experience, and previous experience managing Medicare members.

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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