Telephonic Nurse Care Manager

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must possess a valid and unrestricted Registered Nurse (RN) license with no disciplinary action, and have three or more years of RN experience in a clinical or managed care setting. A current and active Certified Case Manager (CCM) certification is required, along with strong verbal and written communication skills. U.S. Citizenship is mandatory due to the Department of Defense contract.

Responsibilities

The Telephonic Nurse Care Manager will assess, plan, coordinate, implement, monitor, and evaluate the care of beneficiaries, developing personalized care plans in collaboration with physicians and utilizing evidence-based medical information. They will conduct assessments using Motivational Interviewing and solution-oriented approaches to identify gaps in care and needs for services, while maintaining beneficiary privacy and adhering to ethical, legal, and regulatory standards. The role involves providing telephonic care guidance, education, and support to beneficiaries and their families, ensuring adherence to established policies and performance standards, and participating in quality management and professional development activities.

Skills

Care Management

Disease Management

Clinical Assessment

Care Planning

Coordination

Communication

TRICARE Beneficiaries

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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