The Telephonic Care Manager, 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 Telephonic Care Manager work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Role: Telephonic Care Manager, RN
Location: Work at Home, Intermountain Region (WA, OR, ID or UT)
Preferred applicants will live in the Pacific or Mountain time zones, possess three years of varied clinical nursing experience including case management, and have a work at home or telephonic background. Must possess excellent verbal and written communication skills and the ability to work in a fast paced environment.
Responsibilities include: Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria Conduct admission review, post-discharge calls and discharge planning
Required Qualifications Active and unrestricted registered nursing license (RN) in either WA, OR, ID or UT Background working in case management up to and including discharge planning Proficient with Microsoft Office products including Word, Excel and Outlook Ability to work independently under general instructions and with a team Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10 mbs download x 1mbs upload) is required Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.
Preferred Qualifications Bachelor's degree Knowledge of Milliman or Interqual Managed care experience Certified Case Manager (CCM)
Scheduled Weekly Hours
Associated topics: cardiothoracic, intensive care unit, maternal, neonatal, psychatric, psychiatric, registered nurse, staff nurse, tcu, unit