RN, Field Care Manager at Humana

Roanoke, Virginia, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Reside in one of the following counties or independent cities in Virginia: Roanoke, Roanoke City, Salem, Montgomery, Craig, Botetourt, Bedford, Floyd, or Franklin
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, pediatric 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
Ability to travel to region-based facilities and homes for face-to-face assessments and interactions with members and/or families
Valid state driver's license (as part of Humana's driver safety program)
Willingness to participate in Humana’s Tuberculosis (TB) screening program (patient-facing role)

Responsibilities

Perform primarily face-to-face and telephonic assessments to adult and pediatric members to evaluate needs and achieve/maintain optimal wellness
Employ strategies, approaches, and techniques to manage member's health issues and resolve barriers to effective care
Continuously monitor care through assessments, data, conversations with members, and active care planning to ensure progress towards desired outcomes
Manage a caseload and complete assessments with members in their home or community-based settings, as well as telephonically
Provide clinical support and guidance, particularly for members with medical complexity
Develop and coordinate care plans to ensure patients receive appropriate services to manage 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 receive services in the least restrictive setting by assessing care needs to achieve/maintain optimal well-being
Develop and modify Individual Care Plans and involve applicable members of the care team (e.g., informal caregiver, coach, PCP) in care planning
Support members and/or caregivers using an interdisciplinary approach to access social, housing, educational, and other services, regardless of funding sources
Collaborate with Community Health Workers (CHW), Housing Specialists, and other internal/external agencies for health-related social needs (HRSN)
Serve as the primary point of contact for the interdisciplinary care team (ICT), coordinating with the member, ICT participants, and outside resources to meet the member’s needs

Skills

Case Management

Care Planning

Patient Assessment

Telephonic Assessment

Clinical Oversight

Interdisciplinary Care

Medicaid

Home Visits

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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