Humana

Telephonic Nurse Care Manager

Illinois, United States

Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, InsuranceIndustries

Requirements

Licensed Registered Nurse (RN) in Illinois with no disciplinary action or the ability to obtain IL RN licensure is required, along with a minimum of 3 years of clinical acute care experience as a licensed RN. Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook is also necessary. Preferred qualifications include a Bachelor's degree in nursing (BSN), bilingual skills in English/Spanish, English/Polish, or English/Creole, experience with case management, discharge planning, and patient education for adult acute care, managed care experience, certification as a Case Manager (CCM), prior experience with Medicare & Medicaid recipients, experience with health promotion, coaching and wellness, and knowledge of community health and social service agencies.

Responsibilities

The Telephonic Nurse Care Manager will provide personalized assessments, ongoing care planning, and expert guidance over the phone to members in Illinois. They will help members overcome barriers to care, manage chronic conditions, and connect with vital resources. The role involves performing health assessments, care planning, and education on chronic conditions and gaps in health care plans. Responsibilities include employing various strategies to manage members' physical, environmental, and psycho-social health issues, identifying and resolving barriers to effective care, and ensuring patient progress towards desired outcomes through continuous monitoring and active care planning. The nurse will also navigate multiple systems, utilize critical thinking skills, and occasionally travel for training or meetings.

Skills

Registered Nurse (RN)
Clinical acute care
Microsoft Office
Word
Excel
Outlook
Case management
Discharge planning
Patient education
Managed care
Bilingual (Spanish, Polish, Creole)

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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