Humana New Beginnings Case Manager (RN) in San Antonio, Texas

Role: New Beginnings Case Manager (RN) Assignment: Humana Government Business - Clinical Guidance Location: Work at Home- Nationwide (Central and Eastern time zones preferred)

ROLE SUMMARY The New Beginnings Clinical Advisor will have personal interaction with TRICARE beneficiaries identified for New Beginnings program through analytics or referral. The New Beginnings advisor will provide prenatal education and resources on pregnancy, pregnancy-associated conditions, and chronic health conditions affecting pregnancy. The NB Advisor will provide ongoing support for beneficiaries from the earliest stages of pregnancy up to six weeks following birth or longer for infants in NICU. The NB Advisor will serve as a point of contact for pregnant beneficiaries assisting in planning, coordinating, implementing, monitoring, and evaluating medical services needed to meet the healthcare needs of the TRICARE beneficiaries enrolled in the program. The New Beginnings Clinical Advisor will coordinate with hospitals, attending physicians, the beneficiary’s PCM, and other members of the healthcare team to provide ongoing clinical review to include authorizations, concurrent review, and discharge planning services should a mother or infant required extended care. The NB Clinical Advisor will also coordinate care with case managers within HGB’s Integrated Care Team, MTF case managers, and facility case managers. Perform all duties within the scope of his/her practice.

Our Department of Defense Contract requires U.S. citizenship for this position.

  • Utilize applicable sources of information to identify, assess, and enroll patients eligible for the New Beginnings Program. Contact enrolled beneficiaries via outbound calls or preferred method of contact, to assess and provide guidance/education/resources per protocols. Provides a point of contact for beneficiaries with pregnancy / post-partum related needs. Update the Care Management System per HGB Medical Affairs policies and procedures; complete all reporting requirements in a timely manner

  • Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the New Beginnings program, including conducting authorizations, concurrent review, and discharge planning activities for NICU admissions. Will follow admissions through discharge, coordinating care and / or referring cases to Case Management members of the ICT as needed based upon the beneficiaries needs and clinical condition. Maintain beneficiary’s privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.

  • Coordinate and collaborate with other external programs and / or members of the ICT to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting all interventions and outcomes for beneficiaries within the case management and ICT team.

    Role Essentials:

  • Registered Nurse with current in state RN license

  • Case Management Certification (CCM)

  • Three years’ (3) experience in maternal / child nursing with NICU experience

  • Interqual (or Milliman) knowledge

  • Computer literate

  • Good communication skills, verbal and written

  • Good organizational skills

  • U.S. Citizenship is required by our Department of Defense contract

    Role Desirables:

  • Bachelor’s degree in nursing / healthcare

  • Two (2) years case management experience

Title: New Beginnings Case Manager (RN)

Location: Texas-San Antonio

Requisition ID: 175960

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.