Bilingual Telephonic Nurse Care Manager

Illinois, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must be a Licensed Registered Nurse (RN) in Illinois with no disciplinary action or the ability to obtain IL RN licensure. A minimum of 3 years of clinical acute care experience as a licensed RN is required. Bilingual proficiency in English and Spanish, English and Polish, or English and Creole, including speaking, reading, and writing without limitations, is essential. Comprehensive knowledge of Microsoft Office applications, including Word, Excel, and Outlook, is also necessary. Preferred qualifications include a Bachelor's degree in Nursing (BSN), experience with case management, discharge planning, and patient education for adult acute care, managed care experience, Certified Case Manager (CCM) certification, prior experience with Medicare & Medicaid recipients, experience with health promotion, coaching, and wellness, and knowledge of community health and social service agencies.

Responsibilities

The Bilingual Telephonic Nurse Care Manager will support individuals from diverse cultural backgrounds and communities by performing health assessments, care planning, and education on chronic conditions and healthcare plan gaps over the phone for an assigned member population in Illinois. This role involves employing various strategies to manage members' physical, environmental, and psycho-social health issues, identifying and resolving barriers to effective care, and ensuring patient progress towards desired outcomes through continuous monitoring. The nurse will also navigate multiple systems, utilize critical thinking skills, and provide guidance and resources to help members achieve their best health.

Skills

Registered Nurse (RN)

Clinical acute care

Bilingual (English/Spanish, English/Polish, or English/Creole)

Microsoft Office Suite

Word

Excel

Outlook

Case management

Health assessments

Care planning

Chronic condition education

Critical thinking

Telephonic 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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