Field Care Manager

Employment Type: Full-time

Position Overview

Humana Healthy Horizons in Ohio is seeking a Field Care Manager to join our caring community and help us put health first. This role involves assessing and evaluating member's needs and requirements to achieve and/or maintain an optimal wellness state by guiding members and their families toward and facilitating interaction with appropriate resources for their care and wellbeing. Take advantage of Humana's competitive pay, lucrative 401k matching programs, and more! Apply now to begin your future with a Fortune 500 Company!

The Field Care Manager Nurse 2 (Care Manager Plus, Physical Health) has varied work assignments that frequently require interpretation and independent determination of appropriate courses of action.

Responsibilities

The Field Care Manager Plus employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues.

• Identifies and resolves barriers that hinder effective care.
• Utilizes a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs.
• Performs telephonic and face-to-face assessments and evaluations of the member’s needs to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member.
• Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.
• Performs clinical intervention through the development of a care plan specific to each member based on clinical judgment, changes in members’ health or psychosocial wellness, and identified triggers.
• Collaborates with providers and community services to promote quality and cost-effective outcomes.
• Coordinates delivery of needed services/supports for Physical Health, Social Determinant of Health, and value-added benefits.
• Coordinates across the transdisciplinary care team (at a minimum the PCP) and transitions of care.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Submits incident reports.

Specific Responsibilities for PH CM and PH CM Plus:

PH CM: Must perform the full scope of care coordination activities and responsibilities for members who need care coordination and are not assigned to a Care Coordination Entity (i.e., the Ohio RISE Plan, and/or a CME, or who choose to receive their care management from the MCO). The Care Manager serves as the single point of contact for care coordination.

PH CM Plus: Must ensure the completion of the full scope of care coordination activities and responsibilities for members who need care coordination and are assigned to a Care Coordination Entity (i.e., the Ohio RISE Plan, CPCs, and/or a CMEs). The Care Manager Plus serves as the single point of contact for care coordination.

• Ensures the member receives the full scope of care coordination services, including comprehensive assessment completion (inclusive of the HRA), person-centered care plan completion, ensuring no duplication with the CCEs (Ohio RISE Plan, and/or CME), and identifying and addressing ongoing needs.
• Provides actionable data, information, and support to assist the CCE, Ohio RISE Plan, and/or CME in meeting the member's care needs.
• Integrates information collected by the CCE into its Care Coordination Portal to minimize duplication.

Requirements

• Registered Nurse with 2 years of experience in case/care management.
• Experience working with the adult population.
• Knowledge of community health and social service agencies and additional community resources.
• Ability to travel to member's residence within 30 to 40 miles.
• Exceptional communication and interpersonal skills with the ability to quickly build rapport.
• Ability to work with minimal supervision within the role and scope.

Company Information

Humana is a Fortune 500 Company offering competitive pay and lucrative 401k matching programs.