Role: Personal Nurse (RN)
Assignment: Humana Government Business - Clinical Guidance
Location: Work at Home- Nationwide (Central and Eastern time zones preferred)
Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their families. For more than 20 years, Humana Military has strived to create better health outcomes and simplified experiences for millions of beneficiaries across the United States through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, and progressive approaches to care drive Humana Military to be a thought leader in the industry and an essential partner to the Government.
Personal Nurse will be part of the Integrated Care Team (ICT) encompassing Disease Management, Case Management and the Personal Nurse program; providing a comprehensive, holistic approach for care management throughout the continuum of care. They will have personal interaction with beneficiaries to address clinical conditions identified through Predictive Analytics and those important to the beneficiary. The Personal Nurse will assist in planning, coordinating, implementing, monitoring, and evaluating the medical services required to meet the complex health needs of these TRICARE beneficiaries enrolled in the Personal Nurse program to maximize each beneficiary’s capacity for self-care, utilizing coaching and education to cost effectively achieve desired clinical outcomes, and to enhance quality of medical care. The Personal Nurse will assist in conducting post discharge calls for identified patients as they transition from the inpatient setting to home. As part of the Integrated Care Team, the Personal Nurse will be the primary coordinator and point of contact for the beneficiary for all activities within the medical spectrum; including managing case management and disease management conditions and cases. They will coordinate with other members of the ICT, MTF UM staff as necessary and coordinate interventions with the beneficiary’s physicians. Performs all duties with the scope of his/her licensure.
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 chronic care management program. Contact enrolled beneficiaries via outbound calls to further assess and intervene per the chronic care management protocols. Update the Care Management System per HGB Medical Affairs policies and procedures; complete all reporting requirements in a timely manner, and direct administrative staff to complete all mailings within specified timeframes.
Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the Personal Nurse / ICT purview across the continuum of care. Develop a cost effective treatment plan that is acceptable to both the beneficiary (patient) and physician utilizing both evidence based medical information, DoD and community resources. Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care. Maintain beneficiary’s privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.
Place outbound calls to identified beneficiaries within 3 work days of notification hospital discharge to assess for discharge needs, family support, depression status, DME needs, and encourage compliance with discharge instructions and record responses in the Care Management System
Coordinate and collaborate with members of the ICT or other external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting all interventions and outcomes for beneficiaries in the Personal Nurse program and ICT team.
Registered Nurse with current in state RN license
Case Management Certification (CCM)
Minimum of three years clinical experience
Interqual (or Milliman)knowledge
Good communication skills, verbal and written
Good organizational skills
Our Department of Defense Contract requires U.S. citizenship for this position
Bachelor’s degree in nursing / healthcare strongly preferred
Three years’ experience in managed care environment
Title: Personal Nurse
Other Locations: US-TN-Brentwood, US-FL-Tampa, US-Pennsylvania-Pittsburgh, US-New Hampshire-Portsmouth, US-Illinois-Chicago, US-Connecticut-Bridgeport, US-Maine-Portland, US-OH-Cincinnati, US-North Carolina-Charlotte, US-Delaware-Dover, US-Virginia-Hampton, US-South Carolina-Lancaster, US-Louisiana-Metairie, US-Maryland-Bethesda, US-GA-Atlanta, US-New York-Albany, US-IN-Indianapolis, US-HI-Honolulu, US-West Virginia-Charleston, US-Mississippi-Ridgeland, US-Virginia-Glen Allen, US-New Mexico-Albuquerque, US-Massachusetts-Boston, US-Kansas-Overland Park, US-AZ-Phoenix, US-Rhode Island-Newport, US-Idaho-Meridian, US-New Jersey-Jersey City, US-AL-Birmingham, US-Vermont-Montpelier
Requisition ID: 191981
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.