[Remote] RN, Field Care Manager (Adults and Pediatrics) at Humana

Virginia, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Active Registered Nurse (RN) license in the Commonwealth of Virginia without disciplinary action
Two (2) years of prior experience in health care and/or case management
One (1) year of experience working directly with individuals who meet the Cardinal Care Priority Population criteria (adults, pediatrics populations at risk for chronic medical conditions and high social needs)
Strong advocate and respect for members at all levels of care
Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook
Ability to use a variety of electronic information applications/software programs including electronic medical records
Exceptional oral and written communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders
Ability to work with minimal supervision within the role and scope
Ability to work a full-time schedule

Responsibilities

Perform face-to-face and telephonic assessments to adult and pediatric members
Evaluate member's needs to achieve and/or maintain optimal wellness
Manage a case load 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
Develop and coordinate care plans to ensure 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 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
Collaborate with Community Health Workers (CHW), Housing Specialist and other internal and external agencies for HRSN needs
Coordinate with the member, ICT participants, and outside resources to ensure the member’s needs are met

Skills

Key technologies and capabilities for this role

AssessmentCare PlanningPatient AdvocacyTelephonic AssessmentsCommunity-Based CareMedical ComplexityCare Coordination

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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