H

Humana

Sells Medicare health plans and runs senior clinics

Registered Nurse Care Manager

Medical, Clinical & VeterinaryPosted on Nov 13
Full-timeRemote

About the Job

Requirements

  • Be a Registered Nurse licensed in Wisconsin.
  • Have two years of related health care experience.
  • Be able to travel to any location within Racine, Kenosha, Waukesha, Washington, Ozaukee, Walworth, and Sheboygan counties.
  • Have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
  • Complete tuberculosis screening if selected for the patient-facing role.

Responsibilities

  • Complete the nursing portion of comprehensive assessments and provide input to members' care accordingly.
  • Monitor wellness and health promotion activities based on members' assessments and identified outcomes.
  • Re-evaluate members' health and wellness at appropriate intervals to manage ongoing health issues, assess responses to interventions, or respond to medical complaints or events affecting health.
  • Perform routine health monitoring activities based on members' needs.
  • Build constructive working relationships with members, their family members, and appropriate outside agency staff.
  • In crisis situations, assess psychiatric, behavioral, or medical problems and implement interventions in conjunction with other staff to ensure member safety.
  • Evaluate members' ability to safely manage medication, medical care interventions and treatments, equipment, and access to health care services, independently or with supports.
  • Provide or arrange services, supports, or medical care that best meet members' identified needs, and monitor the effectiveness of those interventions.
  • Assist with program, policy, and procedure development and provide input for the quality improvement/quality assurance program.
  • Work as part of an Interdisciplinary Team to manage members enrolled in the Family Care Partnership program.
  • Conduct home and community visits to complete nursing assessments and ensure members have appropriate care and access to services.

Desired Qualifications

  • Have a Bachelor of Science degree in Nursing (BSN).
  • Have previous home health, managed care, or case management experience.
  • Have previous experience working with persons with physical or intellectual/developmental disabilities, or older adults, in a health care setting.
  • Have Case Manager Certification.
  • Have general knowledge of Medicaid and Medicare benefits.

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

Recently Posted Jobs

Explore more opportunities at Humana

See more jobs