RN Case manager at Humana

Eau Claire, Wisconsin, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Associate degree in nursing
Must be a Registered Nurse, licensed in the state of Wisconsin in good standing
Demonstrated intermediate computer proficiency, including experience with Microsoft Office applications
Valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits (part of Humana's driver safety program)
Ability to pass Tuberculosis (TB) screening (patient-facing role)
Preferred Qualifications
Bachelor degree in nursing
One (1) or more years of experience with Family Care target group: frail elders and adults with intellectual, developmental, or physical disabilities
Care Management experience

Responsibilities

Partner with a Care Coach (Case Manager), taking the lead on health-related needs, to collaborate on an ongoing basis regarding the member and their care plan
Conduct regular health assessments for members and implement appropriate strategies and services to develop individualized care plans that support their continued health and safety
Contribute to the creation, continuous evaluation, and coordination of the member’s plan of care, including coordinating with outside providers to provide support with medication administration, assistance with home care, skilled nursing visits, and related services to ensure comprehensive care
Contact and coordinate with acute and primary care providers
Promote health and wellness through patient education on disease prevention, nutrition, exercise, and lifestyle modifications
Provide members with education and information about disease processes and related risks, supporting informed decision-making while respecting each individual's autonomy
Daily documentation in member files within required DHS contract timeframes
Participate in member monthly phone contacts and attend in-person visits in members' settings
Travel up to 40% throughout Eau Claire and surrounding area (eligible for mileage reimbursement)

Skills

Case Management

Care Coordination

Health Assessments

Patient Education

Care Planning

Documentation

Disease Prevention

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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