Pediatric Behavioral Health Nurse Care Manager
Included HealthFull Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
Candidates must possess an active Registered Nurse (RN) license with the ability to be licensed in multiple states without restrictions. A minimum of 2 years of experience in an integrated care setting managing members with behavioral health needs and/or substance use, such as crisis experience, community mental health center, behavioral health inpatient, or assertive community treatment, is required. Preferred qualifications include a Bachelor's degree, RN licensure in a compact state, Psychiatric RN Certification, experience with Medicare and/or Medicare/Medicaid populations, managed care experience, and Spanish speaking skills. The role requires effective communication, interpersonal, and problem-solving skills, along with the appropriate application of clinical knowledge. Candidates must also be able to work between 8 am and 8 pm EST, 40 hours per week with 8-hour shifts, and have reliable internet service with at least 25 Mbps download and 10 Mbps upload speeds, along with a dedicated, interruption-free workspace.
The Behavioral Health Care Manager will telephonically assess and evaluate members' needs and requirements to achieve and maintain optimal wellness, guiding them towards appropriate resources. This role involves managing members challenged by serious mental illness and/or substance use, supporting both their mental and physical health. The manager will employ various strategies to manage members' physical, environmental, and psychosocial health issues, identifying and resolving barriers to effective care. They will continuously monitor patient progress through assessments and evaluations to ensure desired outcomes are met, while understanding department and organizational strategies and operating objectives.
Health insurance provider for seniors and military
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.