Care Manager, Telephonic Registered Nurse

About the role

Humana Care Support is a division of Humana dedicated to helping adults remain independent in their homes. At Humana, our nurses are called Care Managers because our approach is centered on the whole person, not just their condition. In this role, you'll serve as a trusted advocate and partner, helping members navigate the healthcare system and achieve their health goals through compassionate, person-centered care. The Care Manager, Telephonic Nurse 2 partners with members and their families to improve health outcomes through comprehensive assessment, care coordination, and ongoing support. You will help members remain independent in their homes by identifying healthcare needs, removing barriers to care, and connecting members with clinical, community, and social resources that support their overall well-being.

Responsibilities

• Telephonically support Medicare members with transitional care needs and complex chronic conditions.
• Assess members' physical, environmental, behavioral, and psychosocial health needs.
• Continuously assess member progress and adjust care interventions to support optimal health outcomes.
• Develop, implement, and monitor individualized care plans as appropriate.
• Connect members and families with appropriate healthcare, community, and social service resources.
• Coordinate care and collaborate with interdisciplinary teams to address member needs and improve outcomes.
• Employ a variety of clinical strategies and interventions to manage member health concerns.
• Evaluate member risk factors and implement interventions designed to prevent avoidable hospitalizations and emergency department utilization.
• Identify and address barriers to care, including social, financial, environmental, and functional challenges.
• Exercise sound clinical judgment and independent decision-making in a fast-paced care management environment.

Required Qualifications

• An active, unrestricted Registered Nurse (RN) license in state of residence with active Compact (Multistate) licensure with no disciplinary action.
• Three (3) or more years of clinical acute care experience, including case management, discharge planning, and patient education for adult populations.
• Demonstrated clinical expertise managing chronic conditions through assessment, care coordination, clinical intervention, and individualized care planning.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Proficiency with Microsoft Office (Word, Excel, Outlook) and the ability to efficiently navigate multiple systems and applications simultaneously, including dual-monitor environments.
• Ability to manage multiple priorities in a fast-paced, telephonic care management environment.
• Advanced verbal and written communication skills, including the ability to effectively engage members through telephonic and virtual interactions.

Preferred Qualifications

• BSN or MSN degree.
• Managed care experience.
• Certified Case Manager (CCM).
• Bilingual (English and Spanish); with the ability to read, write, and speak in both languages with no limitations or assistance.

Training Schedule

The first 4 weeks of training work hours will be from 8:30AM to 5:00PM Eastern Time (ET). Please note that no time off is permitted during the first month of training, as full attendance is required to successfully complete the onboarding and training program.

Work Schedule

After training, Associates residing in the Eastern Time Zone (ET) will work from 9:00 AM to 5:30 PM ET. Associates residing in the Central Time Zone (CT) will work from 10:00 AM to 6:30 PM ET.

Work Environment

• This is a remote, work-at-home position requiring a dedicated home office workspace.
• Care Managers spend the majority of their day engaging members telephonically through an auto-dialer environment.
• The role requires the ability to build rapport quickly while navigating multiple technology platforms simultaneously.
• Due to business and regulatory requirements, schedules are highly structured with limited day-to-day flexibility.
• Care Managers are expected to meet established quality, productivity, and member outcome goals while demonstrating strong communication and relationship-building skills.

What Makes You Successful In This Role

• You build rapport quickly and create meaningful connections with members in a telephonic environment.
• You are comfortable managing multiple priorities while navigating several technology platforms simultaneously.
• You use critical thinking and sound clinical judgment to address complex member needs.
• You adapt quickly to changing priorities, workflows, and business requirements.
• You thrive in a structured, fast-paced environment while maintaining a high level of quality and member focus.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.
• 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.

Pay

$71,100 - $97,800 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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.