Registered Nurse – RN Field Care Manager at Humana

Detroit, Michigan, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Registered Nurse, Nurse Practitioner, or Clinical Nurse Specialist with a minimum of 2 years experience in health care and/or case management
Active Michigan Registered Nurse (RN) license with no disciplinary action
Must reside in the state of Michigan
Ability to travel to homes and community settings for face-to-face assessments (75% travel to Wayne or Macomb Counties)
Experience working with the adult population and disease management
Knowledge of community health and social service agencies and additional community resources
Exceptional communication and interpersonal skills with the ability to quickly build rapport
Ability to work with minimal supervision within the role and scope
Ability to use a variety of electronic information applications & software programs including electronic medical records
Excellent keyboard and web navigation skills; Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel
Ability to work full-time (40 hours minimum) Mon-Fri
Valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits; access to an automobile
Must have a separate room with a locked door that can be used as a home office to ensure continuous privacy
Accessibility to high-speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed; recommended speed 25Mx10M)

Responsibilities

Manage a caseload and complete assessments with members in their home or community-based setting, as well as telephonically
Provide clinical support and guidance, particularly for members with medical complexity
Help develop and coordinate care plans ensuring that patients receive appropriate services to manage their health needs effectively
Address barriers to health care and advocate for optimal member outcomes
Review, assess, and complete medical complexity attestations and clinical oversights
Ensure members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs
Develop and modify Individual Care Plan and involve applicable members of the care team (Informal caregiver, coach, PCP, etc.) in care planning
Focus on supporting members and/or caregivers utilizing an interdisciplinary approach in accessing social, housing, educational and other services, regardless of funding sources to meet their needs
Serve as primary point of contact for the Interdisciplinary Care Team (ICT) and coordinate with the member, ICT participants, and outside resources to ensure the member’s needs are met

Skills

Registered Nurse

Case Management

Care Planning

Patient Assessment

Home Health Visits

Medicare

Medicaid

Care Coordination

Clinical Oversight

Telephonic Assessments

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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