Become a part of our caring community and help us put health first
 

Humana Healthy Horizons in Ohio is seeking a RN Field Care Manager 2 with Maternity, L&D, Mother Baby expertise. They will assess and evaluate member's needs to achieve and/or maintain optimal wellness. The Field Care Manager will connect members/families with resources appropriate for their care and wellbeing.

The RN, Field Care Manager Nurse 2 works in a CM OR CM Plus capacity based on member’s needs.  Assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities CM:

• Performs the full scope of care coordination activities and responsibilities for members who need care coordination and are not assigned to a Care Coordination Entity (i.e. the Ohio RISE Plan, and/or a CME, or who choose to receive their care management from the MCO).
• Serves as the single point of contact for care coordination. 

Responsibilities CM Plus:

• Ensures the completion of the full scope of care coordination activities and responsibilities for members who need care coordination and are assigned to a Care Coordination Entity (i.e. the Ohio RISE Plan, CPCs, and/or a CMEs).
• Serves as the single point of contact for care coordination.
• Ensures the member receives the full scope of care coordination services, including comprehensive assessment completion (inclusive of the HRA), person-centered care plan completion, ensuring no duplication with the CCEs (Ohio RISE Plan, and/or CME), and identifying and addressing ongoing needs.
• Provides actionable data, information, and support to assist the CCE, Ohio RISE Plan, and/or CME in meeting the member's care needs.
• Integrates information collected by the CCE into its Care Coordination Portal to minimize duplication.

Additional Responsibilities:

• 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. 
• Utilizes a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs.
• Performs telephonic and face to face assessments and evaluations of the member’s needs to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member.    
• Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.  
• Perform clinical intervention through the development of a care plan specific to each member based on clinical judgement, changes in members’ health or psychosocial wellness, and identified triggers.
• Collaborates with providers and community services to promote quality and cost-effective outcomes. 
• Coordinates delivery of needed services/supports for Physical Health, Social Determinant of Health and value-added benefits.
• Coordinates across the transdisciplinary care team (at a minimum the PCP) and transitions of care.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.  
• Submits incident reports.

Use your skills to make an impact
 

Required Qualifications

• Must reside in the state of Ohio.
• Registered Nurse (RN) in the state of Ohio without restrictions.
• Minimum two (2) years of clinical experience (including Maternity, Labor & Delivery, Mother Baby.)
• Intermediate to advanced computer skills and experience with Microsoft Word, Outlook, and Excel; excellent keyboard and web navigation skills. 
• Exceptional communication and interpersonal skills with the ability to quickly build rapport.
• Ability to work with minimal supervision within the role and scope.
• Complete education and self-development activities per Humana Healthy Horizons and departmental requirements.

Preferred Qualifications

• Case Management Certification (CCM).
• Experience working with Medicare, Medicaid or dual-eligible populations.
• Field Case Management Experience. 
• Health Plan experience.
• Knowledge of community health and social service agencies and additional community resources. 
• Experience with health promotion, coaching and wellness. 
• Bilingual (Haitian Creole, Spanish, Somali or other).

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Additional Information

• Workstyle: A combination of working remotely and field-based member v