RN Field Care Manager

Michigan, 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

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess an active Michigan Registered Nurse (RN) license with no disciplinary actions, along with a minimum of 1 year of experience in care management, hospice, home health, or a similar in-home setting. Experience working with adult populations and disease management, knowledge of community health and social service agencies, and exceptional communication and interpersonal skills are required. Additionally, candidates need intermediate to advanced computer skills, including proficiency in Microsoft Word, Outlook, and Excel, the ability to work full-time, and a valid driver's license with appropriate auto insurance and a reliable vehicle. A dedicated, private home office space with high-speed DSL or Cable internet is also mandatory.

Responsibilities

The RN Field Care Manager will manage a caseload, conducting assessments with members in their homes or community settings, as well as telephonically. Responsibilities include providing clinical support and guidance, especially for members with complex medical needs, and developing/coordinating care plans to ensure members receive appropriate services. The role involves addressing barriers to healthcare, advocating for optimal member outcomes, reviewing medical complexity attestations, and assessing care needs to ensure members are served in the least restrictive setting. The Field Care Manager will also develop and modify Individual Care Plans, involving the care team and caregivers, and act as the primary point of contact for the Interdisciplinary Care Team to coordinate services and meet member needs.

Skills

Clinical Support

Care Planning

Medical Complexity Assessment

Home Visits

Community-Based Settings

Advocacy

Interdisciplinary Approach

Social Services

Housing Services

Educational Services

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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