Role: RN Telephonic Senior Case Manager
Location:Virtual - work from home - must be in Eastern time zone
The hours for this role are Mon-Fri, 8am-5pm est.
Humana is seeking a Senior Case Manager who will focus on outreach to Medicare members for short term follow up after being discharged from acute and post acute facilities.Collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.
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
At least 3 years clinical experience in an acute care setting
Previous experience in case management, discharge planning
Experience meeting or exceeding metrics in a dynamic environment
Strong computer and communication skills
Ability to work independently under general instructions and with a team
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana At Home's systems is 10Mx1M
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Bilingual is a plus
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 Telephonic Senior Case Manager - Eastern time zone
Other Locations: US-North Carolina-Charlotte, US-Virginia-Glen Allen, US-FL-Tampa, US-South Carolina-Lancaster
Requisition ID: 178268