Telephonic Care Manager (RN) - Work at home, Texas residence preferred

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.
The Telephonic Care Manager 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.
Required Qualifications
Licensed Registered Nurse (RN) in the state of Texas with no disciplinary action
Associates, Bachelor's degree or work equivalent
At least 3 years of varied clinical nursing experience
Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance for Humana systems is 10Mx1M
Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.
Preferred Qualifications
Experience with discharge planning and patient education for adult acute care
Prior experience working in a telephonic case management or disease management role is a plus
Knowledge of MCG/Milliman or Interqual
Managed care experience
Certified Case Manager (CCM)
Scheduled Weekly Hours

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