RN Case Manager

Wisconsin, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must possess an Associate degree in nursing and be a Registered Nurse, licensed in good standing in the state of Wisconsin. Intermediate computer proficiency, including Microsoft Office applications, is required. A valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits are also necessary. Preferred qualifications include a Bachelor's degree in nursing, over one year of experience with the Family Care target group (frail elders and adults with intellectual, developmental, or physical disabilities), and prior Care Management experience.

Responsibilities

The RN Case Manager will partner with a Care Coach to lead health-related needs and collaborate on member care plans. They will conduct regular health assessments, develop individualized care plans, and coordinate services with outside providers for medication administration, home care, and skilled nursing visits. Responsibilities include contacting acute and primary care providers, promoting health and wellness through patient education on disease prevention, nutrition, exercise, and lifestyle modifications, and educating members about disease processes and related risks. Daily documentation in member files within required DHS contract timeframes, participating in monthly member phone contacts, and attending in-person visits in member settings are also key duties. Traveling up to 40% throughout the Baraboo and surrounding area will be required.

Skills

Nursing

Case Management

Health Assessments

Care Planning

Patient Education

Medication Administration

Disease Prevention

Nutrition

Exercise

Lifestyle Modifications

Documentation

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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