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Humana

Sells Medicare health plans and runs senior clinics

Onsite Care Coordination Nurse

Nursing & Frontline Patient CareUpdated on Nov 9
Full-time

About the Job

Requirements

  • Current, unrestricted Registered Nurse (RN) license in Wisconsin.
  • Must live within a 30–60 minute driving distance of Aurora St. Luke's Medical Center in Milwaukee.
  • At least 3 years of recent acute care nursing experience, such as medical-surgical, critical care, heart/lung, skilled nursing, or rehabilitation.
  • Experience with discharge planning or care coordination in a hospital or health plan setting.
  • Experience using Microsoft Office applications (Word, Outlook, and Excel) and electronic medical records.
  • Valid driver's license, dependable automobile, and proof of personal vehicle liability insurance.
  • Participation in tuberculosis (TB) screening and ACHA Level II background clearance, including fingerprinting, as required by state and company policy.
  • Other credentialing and screening as required by the assigned facility.
  • Must have a private workspace for remote documentation, a download speed of at least 25 Mbps, and an upload speed of at least 10 Mbps. Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.

Responsibilities

  • Conduct comprehensive face-to-face assessments of newly admitted members at assigned acute care facilities to evaluate physical, psychosocial, and health needs, and refer members to Humana programs as appropriate.
  • Support and educate members and families on discharge planning from admission through post-discharge, including facilitating follow-up visits with primary care providers.
  • Identify gaps in care, safety concerns, and barriers to discharge, and develop and implement strategies to address them.
  • Collaborate with attending providers, facility case managers, and other healthcare professionals to ensure timely, coordinated care and effective discharge planning.
  • Educate members on diagnoses, medications, and preventive measures to promote ongoing wellness and reduce readmission risk.
  • Complete required documentation accurately and promptly.
  • Adhere to infection control, safety, and patient privacy standards.

Desired Qualifications

  • Bachelor’s degree in Nursing (BSN).
  • Experience in care management, health promotion, or coaching.
  • Previous utilization management experience.
  • Previous health plan experience.
  • Bilingual ability in English and Spanish.
  • Certification in Care Management or a related specialty.
  • Knowledge of HEDIS and Stars measures.

About the Company

Humana

Sells Medicare health plans and runs senior clinics

Humana sells health insurance paid for by government programs, chiefly Medicare Advantage plans that private insurers run for Americans 65 and older in place of traditional Medicare. It ranks among the largest Medicare Advantage insurers in the country and also runs Medicaid plans for low-income families in several states. Its CenterWell business operates senior primary care clinics, a mail-order pharmacy and home health services, so many members get care from a company the insurer owns. Medicare and states pay Humana a set monthly amount per member, and it keeps the difference between those payments and members' medical costs. Humana was founded in 1961 as a nursing home company and is based in Louisville, Kentucky.

Company size
10,001+
Company stage
IPO
Headquarters
Louisville, KY
Founded
1961

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