RN, Field Care Manager; Adults and Pediatrics

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

Humana Healthy Horizons in Virginia is looking for RN, Field Care Managers (Field Care Manager Nurse
2) who perform primarily face to face and telephonic assessments to adult and pediatric members. The RN, Field Care Manager will evaluate member’s needs to achieve and/or maintain optimal wellness. This position employs a variety of strategies, approaches, and techniques to manage a member’s health issues and identifies and resolves barriers that hinder effective care. They ensure members are progressing towards desired outcomes by continuously monitoring care through use of assessment, data, conversations with member, and active care planning.

Responsibilities

• Manage a case load and complete assessments with members in their home or community-based setting, as well as telephonically.
• Provide clinical support and guidance, particularly for members with medical complexity.
• Develop and coordinate care plans ensuring that patients receive appropriate services to manage their health needs effectively.
• Address barriers to health care and advocate for optimal member outcomes.
• Review, assess, and complete medical complexity attestations and clinical oversights.
• Ensure members are receiving services in the least restrictive setting to achieve and/or maintain optimal well‑being by assessing their care needs.
• Develop and modify Individual Care Plan and involve applicable members of the care team in care planning (informal caregiver, coach, PCP, etc.).
• Support members and/or caregivers utilizing an interdisciplinary approach in accessing social, housing, educational and other services, regardless of funding sources to meet their needs.
• Collaborate with Community Health Workers (CHW), Housing Specialist and other internal and external agencies for HRSN needs.
• Primary point of contact for the ICT and coordinate with the member, ICT participants, and outside resources to ensure the member’s needs are met.

Use your skills to make an impact

Required Qualifications

• Must reside in the Commonwealth of Northern Virginia.
• Active Registered Nurse (RN) license in the Commonwealth of Virginia without disciplinary action.
• Two (2) years of prior experience in health care and/or case management.
• One (1) year of experience working directly with individuals who meet the Cardinal Care Priority Population criteria (adults, pediatrics populations at risk for chronic medical conditions and high social needs).
• Strong advocate and respect for members at all levels of care.
• Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook.
• Ability to use a variety of electronic information applications/software programs including electronic medical records.
• Exceptional oral and written communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.
• Ability to work with minimal supervision within the role and scope.
• Ability to work a full‑time schedule.

Preferred Qualifications

• Prior experience with Medicare, Medicaid and dual eligible populations.
• Bachelor's Degree Nursing (BSN).
• Case Management Certification (CCM).
• Experience with health promotion, coaching and wellness.
• Knowledge of community health and social service agencies and additional community resources.
• Bilingual or Multilingual:
  English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other – Must be able to speak, read and write in both languages without limitations and assistance. See “Additional Information” section for more information.

Additional Information

• Workstyle: Field – This is a field position where employees perform their core duties at non‑company locations, such as providing services at business partner facilities or prospects’ and members’ homes.
• Travel: 50–75% field interactions with members, and their families and providers. May need to attend onsite meetings occasionally in Humana Healthy Horizons office in Glen Allen, VA.
• Workdays and
  
  Hours:
  
  Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Equal Opportunity Employer

Humana is an equal opportunity employer and complies with all applicable civil rights laws. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. We are committed to a diverse workforce and to creating an inclusive environment for all employees.