Job Description: Care Manager, Telephonic Physical Health Nurse

Employment Type: Full time Location Type: [Not Specified] Salary: [Not Specified]

Position Overview

Become a part of our caring community and help us put health first. At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we’ve got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future.

Humana Healthy Horizons is more than a health plan. We’re human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health.

The individual in this role will work as an Oklahoma-based, primarily telephonic care manager, assessing and evaluating enrollees’ needs and requirements to achieve or maintain optimal wellness by guiding enrollees/families towards and facilitating interaction with appropriate resources for their care and wellbeing. The individual in this role will work in collaboration with the interdisciplinary care management team that includes community health workers, housing support specialists, SDOH coordinators, and care management support assistants.

The Care Manager, Telephonic Physical Health Nurse, work assignments are varied but will focus on those enrollees with primarily physical health needs. The Care Manager, Telephonic Physical Health Nurse, will utilize clinical expertise and experience to determine when face-to-face enrollee support is required, engaging the appropriate members of the care management team and/or coordinating in-person meetings between the care manager and the enrollee. This team-based approach is designed to ensure enrollees receive holistic person-centered care.

Responsibilities

• Employs a variety of strategies, approaches, and techniques to manage an Enrollee’s behavioral, physical, environmental, and psycho-social health needs.
• Ensures Enrollees are progressing toward desired outcomes by continuously monitoring their assessments and evaluations.
• Identifies and resolves barriers that hinder effective care and ensures through continuous monitoring of assessments and evaluations that the Enrollee is progressing toward desired outcomes.
• Creates Enrollee care plans, and understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions about their own work methods, occasionally in ambiguous situations, and requires minimal direction, receiving guidance where needed.
• Performs telephonic and face to face assessments and evaluations of the member’s needs and requirements to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member.
• Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.
• Creates member care plans.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Collaborates with providers and community services to promote quality and cost-effective outcomes.
• Follows established guidelines/procedures.
• Possible travel to Humana Oklahoma office for meetings and training.

Required Qualifications

• Must reside in Oklahoma.
• Active Registered Nurse (RN) license, or a Licensed Master Level Social Worker ((LCSW, LMSW, LMSW-ACP, CSW, LPC, LMFT).
• Minimum 1-year clinical experience.
• 2 or more years of care management.
• Experience working with Medicaid and/or Medicare Enrollees to coordinate services, care needs or benefits.
• Knowledge of community health and social service agencies and additional community resources.

Company Information

About Humana Healthy Horizons: Humana Healthy Horizons is more than a health plan. We’re human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health.

Use your skills to make an impact.