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 Humana Healthy Horizons in Ohio is seeking a Field Care Manager to assess and evaluate member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.

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The Field Care Manager Nurse 2 (Care Manager Plus, Physical Health) work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Additional responsibilities for the PH CM are further defined by these two separate roles:

The PH CM must perform the full scope of care coordination activities and responsibilities for members who need care coordination and are not assigned to a Care Coordination Entity (i.e. the Ohio RISE Plan, and/or a CME, or who choose to receive their care management from the MCO). Care Manager serves as the single point of contact for care coordination. 

Or

The PH CM Plus must ensure the completion of the full scope of care coordination activities and responsibilities for members who need care coordination and are assigned to a Care Coordination Entity (i.e. the Ohio RISE Plan, CPCs, and/or a CMEs). Care Manager Plus serves as the single point of contact for care coordination.

Ensuring the member receives the full scope of care coordination services, including comprehensive assessment completion (inclusive of the HRA), person-centered care plan completion, ensuring no duplication with the CCEs (Ohio RISE Plan, and/or CME), and identifying and addressing ongoing needs.Providing actionable data, information, and support to assist the CCE, Ohio RISE Plan, and/or CME in meeting the member's care needs.Integrating information collected by the CCE into its Care Coordination Portal to minimize duplication.

Position Responsibilities:

The Field Care Manager Plus employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. 

Utilize a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs.Performs telephonic and face to face assessments and evaluations of the member’s needs to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member.    Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.  Perform clinical intervention through the development of a care plan specific to each member based on clinical judgement, changes in members’ health or psychosocial wellness, and identified triggersCollaborates with providers and community services to promote quality and cost-effective outcomes. Coordinates delivery of needed services/supports for Physical Health, Social Determinant of Health and value added benefits.Coordinates across the transdisciplinary care team (at a minimum the PCP) and transitions of careUnderstands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.  Submits incident reports

Use your skills to make an impact
 

Required Qualifications

Registered Nurse with 2 years of experience of in home case/care managementExperience working with the adult populationKnowledge of community health and social service agencies and additional community resourcesAbility to travel to member's residence within 30 to 40 milesExceptional communication and interpersonal skills with the ability to quickly build rapportAbility to work with minimal supervision within the role and scopeAbility to use a variety of electronic information applications/software programs including electronic medical recordsIntermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and ExcelExcellent keyboard and web navigation skillsAbility to work a full-time (40 hours minimum) flexible work scheduleThis role is a part of Humana's Driver Safety program and therefore requires and individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits.Must have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you workMust 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 systems if 5Mx1MThis role is considered patient facing and is part of Humana At Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.Valid driver's license, car insurance, and access to an automobileAssociates working in the State of Florida will need ACHA Level II Background clearanceMust be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

BSN3-5 years of in home assessment and care coordination experienceExperience with health promotion, coaching and wellnessPrevious managed care experienceBilingual — English, SpanishCertification in Case ManagementMotivational Interviewing Certification and/or knowledge

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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.

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$71,100 - $97,800 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.