Care Manager, Telephonic Nurse
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AI Summary
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As a remote Telephonic Care Manager you will report to a Manager of Care Management. You will be providing a comprehensive, holistic approach for Case Management (CM) Special Populations program throughout the continuum of care. You will provide case management specialized interventions by leveraging the most appropriate care sites and levels of care to prevent or decrease hospital readmissions, promoting appropriate utilization of alternative sources of available funding, enhancing coordination of care, and reducing fragmentation of clinical services.You will serve as the point of contact in the Special Populations Program for the beneficiary for all activities within the clinical spectrum. You will coordinate and collaborate within the Care Management programs, Military Treatment Facility (MTF) Utilization Management/Case Management/CM staff, physicians or providers to ensure there is a fully integrated care plan addressing all beneficiary needs and conditions.
Use your skills to make an impact
Required Qualifications
- Our Department of Defense Contract requires U.S. citizenship for this position.
- Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
- HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
- Active RN license in state of employment
- Ability to obtain CCM certification within 1 year of hire
- 2 years case management experience
- 3 years clinical RN or managed care RN experience
Preferred Qualifications
- Bachelor's degree in nursing
- TRICARE experience
- Experience with MCG
- Current CCM
Additional Information
Work Style: Remote Work Schedule: Monday – Friday; must be able to work an 8-hour shift between the hours of 8:00 a.m. – 6 p.m. EST (Eastern Standard Time)
Training/Training Hours: Mandatory for the first 4 weeks between the hours 8:00 a.m. – 5:00 p.m. EST (Eastern Standard Time)
Work at Home Requirements
To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates 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 associates 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
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40Pay 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.
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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 07-29-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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 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.
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