Metairie, LA, United States
Feb 01, 2021
The Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates members' 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. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Location: work at home, must hold a Compact license in a compact state
The Transplant Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage the transplant member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. In this role you will:
Act as the member and provider single point of contact for all transplant, ventricular access device (VAD), and chimeric antigen receptor T cell (CAR-T) therapy services
Guide members by providing information and resources that enable the member to make informed decisions
Educate the member on their benefits, and guide the member to maximize their benefit
Discussion of benefits to help guide members to participating Transplant centers and benefit maximization
Work tasks assigned in the clinical documentation system
Work assigned UM and CM cases within compliance timelines
Build and update UM & CM cases as appropriate
Arrange for transfers to alternative levels of care using clinical knowledge and benefit plan design and identify potentially unnecessary services and care delivery settings and recommend alternatives, if appropriate by analyzing clinical protocols
Complete Inpatient reviews as appropriate
Collaborate with Transplant Medical Directors as appropriate
Identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria/guidelines
Discharge planning, as appropriate and complete Post discharge calls and follow up calls, as appropriate
Hours are 8:30- 5 p.m. EST for this role
Licensed Registered Nurse (RN) in appropriate state with no disciplinary action.
Compact state license: must reside in a compact state with the ability to obtain multiple state licenses without restrictions
5 or more years of clinical nursing
3 years of critical care experience, i.e.: ICU, step down, ER, LTAC, etc.
Proficient with various EMRs
Microsoft Office applications including Word, Excel, and Outlook
Must have a separate room for privacy with a locked door during working hours and during communication with members.
Must provide hardwired high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service are prohibited). A minimum standard speed of10x1 (10mbs download x 1mbs upload) for optimal performance of is required
Must be able to work 8:30-5:00 PM Eastern hours
Ability to travel less than 10% annually once travel restrictions are lifted
Experience working in Utilization Management within last 2 years
Experience with case management, discharge planning and patient education for adult acute care
Knowledge of Milliman or Interqual
Managed care experience
Certified Case Manager (CCM)
Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Scheduled Weekly Hours