Care Manager Nurse - RN - Fayetteville, AR - Full-time / Part-time

Role: Care Manager Nurse - RN

Assignment: Humana (Management Services Organization) MSO

Location: Overland Park, KS

Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule

The Humana MSO is seeking a Care Manager Nurse who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines including Quality and Risk adjustment initiatives.

Manage team of Care Navigators working with PCP’s to identify care gaps prior to member appointments

Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally

Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols

Develop, enhance and maintain provider clinical relationships

Partner with physicians/practice staff to encourage and influence member participation in clinical programs and completion of HEDIS gaps.

Identify underlying issues that contribute to gaps in care and/or high utilization and work with provider to problem solve and implement successful strategies.

Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria

Key Competencies

Builds Trust : Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.

Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same.

Customer Focus : Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.

Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. Role Essentials

Active RN license is designated state

Ability to be licensed in multiple states without restrictions

Experience in utilization or case management

Strong computer and communication skills

Demonstrated leadership ability

Ability to work independently under general instructions and with a team

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be tested for TB.

Role Desirables

BSN

CCM

Health Plan experience highly desired

Prior management (team leadership) experience

Previous Medicare/Medicaid experience

Reporting Relationship

This role reports to the Market Medical Director

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.