Role: RN Telephonic Case Manager
Location:Work at home, eastern time zone
The hours of this role are Mon-Fri, 8am-5pm est.
Humana is seeking a RN Case Manager to focus on ER initiatives, addressing predictive model and retrospective referred members related to emergency room utilization or predicted utilization.
Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design
Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally
Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols
Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria
Conduct admission review, post-discharge calls and discharge planning
Active RN license in the state(s) in which the nurse is required to practice
Ability to be licensed in multiple states without restrictions
Prior clinical experience in an acute care, skilled or rehabilitation clinical setting
Strong computer skills
Proven ability meeting or exceeding metrics and deadlines
Education: BSN or Bachelor’s degree in a related field
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Previous experience case management
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Title: RN Teleohonic Case Manager - GA or eastern time zone
Requisition ID: 178269