Telephonic Nurse Case Manager
Humana
Become a part of our caring community and help us put health first
The Telephonic Nurse Case Manager will be a member of the In-Home Case Management Team, providing a comprehensive, holistic approach for case management throughout the continuum of care. The case manager will offer guidance, support, and coordination of the beneficiary’s care as directed by the beneficiary, the provider(s) or other members of the healthcare team and within the scope of the case manager’s licensure. The case manager will assess, plan, coordinate, implement, monitor, and evaluate the medical services required to meet the complex health needs of TRICARE beneficiaries, to maximize each beneficiary’s capacity for self- care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care.The Telephonic Nurse Case Manager will collect and document data to facilitate measurement of case management involvement. The case manager will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical and behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in addition to MTF UM / CM staff, physicians and providers as necessary; organize, arrange and coordinate services necessary to address the beneficiary’s condition. In their role, the Case Manager will collaborate with other care management programs until the beneficiary’s needs are met, and case closure or graduation is achieved. Performs all duties within the scope of his/her licensure.
KEY ACCOUNTABILITIES
35% Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the Case Management purview across the continuum of care. Develop a cost effective treatment plan that is acceptable to both the beneficiary (patient) and other members of the care team utilizing both evidence based medical information, DoD and community resources (SDOH). Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care. Maintain beneficiary’s privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.
30% Utilize applicable sources of information to identify, assess, and enroll patients requiring case management.
25% Coordinate and collaborate with other members of the care management team or external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the case management team.
10% Support the Care Coordinators with the coordination of care for beneficiaries not under case management as needed.
Use your skills to make an impact
Required Qualifications
Bachelor's degree in Nurse (BSN).
Valid and unrestricted Registered Nurse (RN) license in the (appropriate state) with no disciplinary action.
An active designation as a Certified Care Manager (CCM). If no active designation as a CCM at hire date, you must be able to obtain a CCM within the first year of hire.
Three (3) or more years of clinical acute care experience.
Strong communication skills both verbal and written.
Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Our Department of Defense Contract requires U.S. citizenship for this position.
Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS).
HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
Preferred Qualifications
2 or more years of experience with case management, discharge planning and patient education for adult acute care.
Experience with TRICARE policies and/or the military health care delivery system.
Knowledge of MCG or Interqual.
Managed care experience.
Additional Information
Work Days/Hours: Monday – Sunday; must be able to work an 8-hour shift sometime between the hours of 8:00 a.m. – 6 p.m. in your reflective time zone, 40 hours a week plus additional hours for potential overtime and rotating hours for weekends/holidays.
Training/Training Hours: Mandatory for the first 4 – 6 weeks; 8:00 a.m. – 5:00 p.m. Eastern Standard Time.
Work Style: Remote
Work at Home/Remote Requirements
To ensure Hybrid Office/Home associates’ ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
HireVue Statement: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-29-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.