Humana RN Care Manager - Telephonic Nurse 2 (Autism Care Navigator) - Remote, United States in Lancaster, South Carolina
The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The RN Care Manager, Telephonic Nurse 2 (Autism Care Navigator) serves as a primary advocate for assigned beneficiaries receiving care under the Autism Care Demonstration (ACD). The ASN (Autism Care Navigator) collaborates and oversees the assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. Coordinate medical, behavioral and other services for beneficiaries with a primary diagnosis of ASD, as defined by the ACD. Additionally, this role serves as a Humana Military liaison to TRICARE beneficiaries, providers and others involved in the care planning for beneficiaries receiving services under the TRICARE program.
Serves as primary advocate for beneficiary & family collaborating with other CMs to coordinate care activities; conduct assessment for development of comprehensive care plan (CCP); update CCP at least every 6 months; complete PSI or SIPA as indicated; notify & provide copy of CCP to providers & parents/caregivers; ensure all baseline measures are completed as required by ACD policy; administer &/or collect outcome measures as defined by ACD policy, provide outcome measure data to respective providers; serve as POC for MTF CMs.
Perform telephonic care management with beneficiaries throughout the East region with a focus of coordination of services for any treatment pertaining to ASD.
Assess the needs of identified beneficiaries and collaborate with providers, caregivers/guardians and others as necessary to ensure treatment is initiated and any barriers are addressed.
Assess the needs of the family and determine necessary resources to include but not limited to educational programs, community resources, educational materials, and support groups
Participate in care management and coordination of services in an effective and efficient manner in accordance with Medical Management policies and procedures.
Utilize Motivational Interviewing and solution-oriented approaches in communication.
Work collaboratively with stakeholders across the Enterprise to provide consultative assistance, coordination of services, and participate in integrated care plan meetings as appropriate
Develop comprehensive care plans in collaboration with identified stakeholders when appropriate.
Provide professional and courteous service to all callers and work to resolve any complaint or issue to their satisfaction when possible.
Participates in Coordinated Team Conferences; includes medical team conferences involving three or more providers rendering care to beneficiaries with ASD under the ACD. The conversation should revolve around coordination of services and ensuring goals are appropriate and not in conflict to the treatment plans by any other services received by the beneficiary. Team conferences for complex beneficiaries with ASD and other co-occurring conditions that impact services being successful in the management of ASD. Ensures providers comply with attendance and policies outlined in the TOM for conferences. Serve as meeting facilitator, created documented summary of meeting minutes and share copy with stakeholders.
Actively communicate with other ASNs and/or facilitate continuity of care to ensure care transition with beneficiary relocations (regions and or markets).
Assist family in identifying local & or other resources that could benefit the beneficiary to include Respite care for ADFMs.
Monitor ECHO registration and EFMP enrollment for beneficiaries with qualifying diagnosis, ensuring required documentation is received.
Maintain provisional list to ensure completion of required application process.
Follow beneficiary to ensure coordination and approval of services.
Assess the needs of identified beneficiaries and work collaboratively to ensure care coordination assistance.
Ensure data is entered accurately and monitor report to make any necessary corrections so that reporting is accurate.
Our Department of Defense Contract requires U.S. citizenship for this position.
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing).
A current, valid, and unrestricted RN license.
Must have clinical experience in: pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience.
Minimum of 3 years of clinical nursing experience.
Minimum of 1 year of managed care and case management experience.
An active designation as a Certified Care Manager (CCM). If no active designation as a CCM at hire date, this must be obtained within the first year of hire.
Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook.
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
Must have a separate room with a locked door that can be used as a home office, to ensure you and your patients have absolute and continuous privacy while you work.
Skilled in written and verbal communications.
Ability to handle high volume of calls and customer contacts in a polite and professional manner.
Ability to handle multiple projects simultaneously and to prioritize appropriately.
Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test.
Prior experience with the TRICARE Autism Care Demonstration.
Knowledge of and experience with applied behavior analysis and integrated care needs for those with autism.
Direct or Indirect Military experience a plus.
Certified Case Manager (CCM).
Extensive analytical skills.
Bilingual a plus.
The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.
Work Days/Hours : Monday - Friday; must be able to work an 8 hour shift between 8:00 am - 7pm EST.
Training/Training Hours: Mandatory for the first 4 - 6 weeks; 8:00am - 4:00pm EST
As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours