[Remote] Telephonic Nurse Case Manager at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor's degree in Nurse (BSN)
Valid and unrestricted Registered Nurse (RN) license in the (appropriate state) with no disciplinary action
Active designation as a Certified Care Manager (CCM)
Three (3) or more years of clinical acute care experience
Strong communication skills both verbal and written
Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook
U.S. citizenship
Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)

Responsibilities

Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the Case Management purview across the continuum of care
Develop a cost-effective treatment plan that is acceptable to both the beneficiary and other members of the care team utilizing evidence-based medical information, DoD and community resources (SDOH)
Utilize applicable sources of information to identify, assess, and enroll patients requiring case management
Coordinate and collaborate with other members of the care management team or external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the case management team
Support the Care Coordinators with the coordination of care for beneficiaries not under case management as needed
Collect and document data to facilitate measurement of case management involvement
Serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical and behavioral health spectrum
Coordinate with other Medical Management programs (DM/PN) as needed, in addition to MTF UM / CM staff, physicians and providers as necessary; organize, arrange and coordinate services necessary to address the beneficiary’s condition
Collaborate with other care management programs until the beneficiary’s needs are met, and case closure or graduation is achieved
Performs all duties within the scope of his/her licensure

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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