Humana Case Manager - Special Population - RN in Portland, Maine

Role : Case Manager, RN – Special Population

Assignment: Humana Government Business - Clinical Guidance

Location: Work at Home


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.


The Clinical Advisor, Special Population, will be a member of the HGB’s Population Health Department which focuses on those beneficiaries with unique care needs. The clinical advisor will offer guidance and support for the beneficiary’s care, specifically focusing case management efforts in the delivery of care to special populations; to include but not limited to Transplants, NCI Clinical Trials, ECHO/EHHC and ICMP/CCTP; providing a comprehensive, holistic approach for care management throughout the continuum of care. The case manager will offer guidance and support of the beneficiary’s care as directed by the patient’s provider(s) and within the scope of the case manager’s licensure. The case manager will assess, plan, coordinate, implement, monitor, and evaluate the medical services required to meet the complex health needs of TRICARE beneficiaries, to maximize each beneficiary’s capacity for self-care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care. The case manager will collect and document data to facilitate measurement of case management involvement. As part of the Population Health/ Special Population Team, the case manager, will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical spectrum, including collaboration with Behavioral Health Case Management on cases with dual diagnosis. They will also coordinate with other members of the Integrated Care Team (ICT) as needed, in addition to MTF UM / CM staff, physicians and providers as necessary and coordinate and arrange services necessary to address the beneficiary’s condition. In their role, the Clinical Advisor, case manager, will collaborate/coordinate services with the ICT or other care management programs, to include, but not limited to, Humana at Home, New Beginnings, and End of Life services until the beneficiary’s needs are met and case closure or graduation is achieved. Performs all duties within the scope of his/her licensure.

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

Assignment Capsule

· Utilize applicable sources of information to identify, assess, and enroll patients requiring case management

· Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under Population Health/Special Population purview across the continuum of care. Develop a cost effective treatment plan that is acceptable to both the beneficiary (patient) and other members of the care team 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.

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

· Other duties as assigned .

Role Essentials

  • Registered Nurse with current in state RN license

  • Certified Case Management

  • 2 years Case Management Experience with emphasis on transplants/clinical trials or complex pediatrics

  • Interqual (or Milliman) knowledge

  • Computer literate

  • Good communication skills, verbal and written

  • Good organizational skills

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

    Role Desirables

    · Bachelors degree or health related field

    · TRICARE Experience

Title: Case Manager - Special Population - RN

Location: AL-Birmingham

Other Locations: US-TN-Brentwood, US-FL-Tampa, US-Pennsylvania-Pittsburgh, US-Michigan-Troy, 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-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-Minnesota-Minneapolis, US-Rhode Island-Newport, US-New Jersey-Jersey City

Requisition ID: 191083

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.