Care Manager, Telephonic Nurse 2 - Humana Government Business

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.
The Care Manager, Telephonic Nurse 2 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. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Assignment Capsule
The Case Manager will be a member of the HGB's Integrated Care Team (ICT) encompassing Case Management, Disease Management, and the Personal Nurse program; 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 Integrated Care 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 Humana Behavioral Health Case Management on cases with dual diagnosis. They will also coordinate with other members of the 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 Case Manager will collaborate/coordinate services with 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.
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 the Case Management / ICT 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 ICT or external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the case management and ICT team.
Support the Patient Care Coordinators with the coordination of care for beneficiaries not under case management as needed.
Role Essentials
Active licensed RN in state of employment
Case Management Certification (CCM) required
Three years clinical or managed care experience
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
Bachelor's degree in nursing or health related field
Two years case management experience
Additional Information
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice 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.
If you are selected for a first round interview, you will receive a correspondence inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you
Scheduled Weekly Hours

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