[Remote] RN, Field Care Manager, Maternity, L&D, Mother Baby at Humana

Ohio, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Registered Nurse (RN) in the state of Ohio without restrictions
Minimum two (2) years of clinical experience (including Maternity, Labor & Delivery, Mother Baby)
Must reside in the state of Ohio
Intermediate to advanced computer skills and experience with Microsoft Word, Outlook, and Excel; excellent keyboard and web navigation skills
Exceptional communication and interpersonal skills with the ability to quickly build rapport
Ability to work with minimal supervision within the role and scope
Complete education and self-development activities per Humana Healthy Horizons and departmental requirements

Responsibilities

Performs the full scope of care coordination activities for members who need care coordination and are not assigned to a Care Coordination Entity
Serves as the single point of contact for care coordination
Ensures the completion of the full scope of care coordination activities for members assigned to a Care Coordination Entity
Ensures the member receives the full scope of care coordination services, including comprehensive assessment completion, person-centered care plan completion, and identifying and addressing ongoing needs
Provides actionable data, information, and support to assist the CCE, Ohio RISE Plan, and/or CME in meeting the member's care needs
Integrates information collected by the CCE into its Care Coordination Portal to minimize duplication
Employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental and psycho-social health issues
Identifies and resolves barriers that hinder effective care
Utilizes a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs
Performs telephonic and face to face assessments and evaluations of the member’s needs to achieve and/or maintain an optimal wellness state
Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations
Perform clinical intervention through the development of a care plan specific to each member based on clinical judgement, changes in members’ health or psychosocial wellness, and identified triggers
Collaborates with providers and community services to promote quality and cost-effective outcomes
Coordinates delivery of needed services/supports for Physical Health, Social Determinant of Health and value-added benefits
Coordinates across the transdisciplinary care team (at a minimum the PCP) and transitions of care
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
Submits incident reports

Skills

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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