Telephonic RN Transplant Care Manager

Profile

Description

The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.

Responsibilities

Location: work at home, must hold a Compact license in a compact state

Hours: 8:30AM-5:00 PM Eastern Time Zone

The Transplant Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage the transplant member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. In this role you will:

Act as the member and provider single point of contact for all transplant, ventricular access device (VAD), and chimeric antigen receptor T cell (CAR-T) therapy services

Guide members by providing information and resources that enable the member to make informed decisions

Educate the member on their benefits, and guide the member to maximize their benefit

Discussion of benefits to help guide members to participating Transplant centers and benefit maximization

Work tasks assigned in the clinical documentation system

Work assigned UM and CM cases within compliance timelines

Build and update UM & CM cases as appropriate

Arrange for transfers to alternative levels of care using clinical knowledge and benefit plan design and identify potentially unnecessary services and care delivery settings and recommend alternatives, if appropriate by analyzing clinical protocols

Complete Inpatient reviews as appropriate

Collaborate with Transplant Medical Directors as appropriate

Identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria/guidelines

Discharge planning, as appropriate and complete Post discharge calls and follow up calls, as appropriate

Hours are 8:30- 5 p.m. EST for this role

Required Qualifications

Licensed Registered Nurse (RN) in appropriate state with no disciplinary action.

Compact state license: must reside in a compact state with the ability to obtain multiple state licenses without restrictions

5 or more years of clinical nursing

3 years of critical care experience, i.e.: ICU, step down, ER, LTAC, etc.

Proficient with various EMRs

Microsoft Office applications including Word & Excel

Must have a separate room for privacy with a locked door during working hours and during communication with members.

Must be able to work 8:30-5:00 PM Eastern hours

Ability to travel less than 10% annually once travel restrictions are lifted

Preferred Qualifications

BSN degree

Experience working in Utilization Management within last 2 years

Experience with case management, discharge planning and patient education for adult acute care

Knowledge of Milliman or Interqual

Managed care experience

Certified Case Manager (CCM)

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information - How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Interview Process

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a text message pre-screen to learn more about your background.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com