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Telephonically support Medicare members with transitional care needs and complex chronic conditions.
Assess members' physical, environmental, behavioral, and psychosocial health needs.
Continuously assessing member progress and adjust care interventions to support optimal health outcomes.
Develop, implement, and monitor individualized care plans as appropriate.
Connect members and families with appropriate healthcare, community, and social service resources.
Coordinate care and collaborate with interdisciplinary teams to address member needs and improve outcomes.
Employ a variety of clinical strategies and interventions to manage member health concerns.
Evaluate member risk factors and implement interventions designed to prevent avoidable hospitalizations and emergency department utilization.
Identify and address barriers to care, including social, financial, environmental, and functional challenges.
Exercise sound clinical judgment and independent decision-making in a fast-paced care management environment.
An active, unrestricted Registered Nurse (RN) license in state of residence with active Compact (Multistate) licensure with no disciplinary action.
Three (3) or more years of clinical acute care experience, including case management, discharge planning, and patient education for adult populations.
Demonstrated clinical expertise managing chronic conditions through assessment, care coordination, clinical intervention, and individualized care planning.
Strong clinical assessment, critical thinking, and decision-making skills.
Proficiency with Microsoft Office (Word, Excel, Outlook) and the ability to efficiently navigate multiple systems and applications simultaneously, including dual-monitor environments.
Ability to manage multiple priorities in a fast-paced, telephonic care management environment.
Advanced verbal and written communication skills, including the ability to effectively engage members through telephonic and virtual interactions.
Bilingual (English and Spanish); with the ability to read, write, and speak in both languages with no limitations or assistance.
Training Schedule: The first 4 weeks of training work hours will be from 8:30AM to 5:00PM Eastern Time (ET).Please note that no time off is permitted during the first month of training, as full attendance is required to successfully complete the onboarding and training program.
Work Schedule: After training, Associates residing in the Eastern Time Zone (ET)will work from 9:00 AM to 5:30 PM ET. Associates residing in the Central Time Zone (CT) will work from 10:00 AM to 6:30 PM ET.
Work Environment
This is a remote, work-at-home position requiring a dedicated home office workspace.
Care Managers spend the majority of their day engaging members telephonically through an auto-dialer environment.
The role requires the ability to build rapport quickly while navigating multiple technology platforms simultaneously.
Due to business and regulatory requirements, schedules are highly structured with limited day-to-day flexibility.
Care Managers are expected to meet established quality, productivity, and member outcome goals while demonstrating strong communication and relationship-building skills.
What Makes You Successful in This Role
You build rapport quickly and create meaningful connections with members in a telephonic environment.
You are comfortable managing multiple priorities while navigating several technology platforms simultaneously.
You use critical thinking and sound clinical judgment to address complex member needs.
You adapt quickly to changing priorities, workflows, and business requirements.
You thrive in a structured, fast-paced environment while maintaining a high level of quality and member focus.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
Originally posted on Himalayas