Care Coordination Nurse

• Conduct comprehensive face-to-face assessments of newly admitted members at assigned acute care facilities
• Evaluate physical, psychosocial, and health needs and refer members to Humana programs as appropriate
• Support and educate members and families on discharge planning from admission through post-discharge
• Facilitate follow-up visits with primary care providers
• Identify gaps in care, safety concerns, and barriers to discharge
• Develop and implement strategies to address care and discharge barriers
• Collaborate with attending providers, facility case managers, and other healthcare professionals
• Ensure timely, coordinated care and effective discharge planning
• Educate members on diagnoses, medications, and preventive measures
• Promote ongoing wellness and reduce readmission risk
• Complete required documentation accurately and promptly
• Maintain infection control, safety, and patient privacy standards
• Work at assigned onsite facilities with limited remote hours for coordination and documentation

• Current, unrestricted Registered Nurse (RN) license in the state of Indiana
• Must live within a 30–60 minute driving distance of Memorial Hospital - 615 N Michigan Street from home base
• Minimum of 3 years recent acute care nursing experience
• Experience with discharge planning or care coordination in a hospital or health plan setting
• Experience with Microsoft Office applications (Word, Outlook, Excel) and electronic medical records
• Valid driver’s license, dependable automobile, and proof of personal vehicle liability insurance
• Participation in Tuberculosis (TB) screening and ACHA Level II background clearance, including fingerprinting
• Other credentialing and screening as required by assigned facility
• Must have a private workspace for remote documentation
• Dedicated workspace without ongoing interruptions to protect member PHI / HIPAA information
• Home internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps
• Preferred:
  Bachelor’s degree in Nursing (BSN)
• Preferred:
  Experience in care management, health promotion, or coaching
• Preferred:
  Previous Utilization Management experience
• Preferred:
  Previous health plan experience
• Preferred:
  Bilingual English/Spanish
• Preferred:
  Certification in Care Management or related specialty
• Preferred:
  Knowledge of HEDIS and Stars measures

Demonstrates expertise in acute care nursing, discharge planning, and care coordination, ensuring effective communication and collaboration with healthcare professionals. Proficient in educating members on health needs and maintaining compliance with safety and privacy standards.

• Registered Nurse (RN) License
• Acute Care Nursing Experience
• Discharge Planning Experience
• Care Coordination
• Bilingual English/Spanish

• Acute Care Nursing
• Discharge Planning
• Care Coordination
• Health Education
• Documentation Accuracy
• Infection Control
• Patient Privacy Standards
• HEDIS Knowledge
• Stars Measures Knowledge

• Collaboration
• Communication
• Problem-Solving
• Empathy

• Certification in Care Management

• Health Promotion
• Utilization Management
• Acute Care Facilities
• Patient Safety
• Care Gaps Identification

• Microsoft Office
• Electronic Medical Records