NICU Care Manager Telephonic Nurse 2

Profile

Description

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.

Responsibilities

Location: work at home anywhere

Humana is seeking a NICU Care Manager, Telephonic Nurse 2 who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria. You will follow our tiniest members from the beginning of their NICU stays until discharge! You will be identifying and utilizing appropriate healthcare resources most consistent with the member's needs and by providing guidance along the healthcare continuum.

You will perform clinical case review on members during an inpatient hospital admission. You will collaborate with other health care providers in reviewing actual and proposed medical care and services. You will work to assess care needs, assist in coordinating interventions and services to meet those needs, and communicating with providers and Humana associates to promote efficient use of the healthcare system.

This work may the ability to work via cable or DSL modem from home in a secure environment where confidentiality of member and company information can be maintained. Please note this is a fast-paced role with lots of moving parts which will require a candidate that is organized, hardworking and quick to learn.


Provide authorizations for inpatient stay
Provide care coordination and discharge planning
Provide home health and medical equipment coordination.
Partner with facilities to support superior care
Hours of operation are Monday through Friday 8:30-5 p.m. EST OR CST
This role will require on call for rotating holidays. Please not training may be conducted in an alternate time zone virtually


Role Essentials


3-5 years or more of NICU level 3 experience and/or Pediatric ICU experience
Active RN license in the state(s) in which the nurse is required to practice
Ability to be licensed in multiple states without restrictions
Ability to work independently under general instructions and with a team
Team player
Strong organizational skills and experience multi-tasking
Knowledge of NICU and/or pediatric terminology, care concepts
Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work


Role Desirables


Education: BSN or Bachelor's degree in a related field
Health Plan experience
Previous experience in utilization management, discharge planning and/or home health or rehab
Bilingual is a plus - preferably Spanish


Additional Information

Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

Company info

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