Pediatric Field Care Manager, RN, LCSW, LPN

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

The Pediatric Field 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.

Location:  Must reside within following regions/counties

Region 1: Walton or Okaloosa
Region 7: Seminole, Orange, Osceola, Brevard

               

The Pediatric Field Care Manager Nurse 2 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.

• Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations.

• May create member care plans.

• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

• Follows established guidelines/procedures.

Enhanced Care Coordination (ECC) ECC helps to connect children diagnosed with but not limited to Chronic medical conditions, congenital conditions, developmental disabilities, and learning disabilities to care services. The ECC Case Manager (CM) assists families (if applicable) to coordinate care services while respecting the families right to decide the appropriate care setting for the child. ECC CM will collaborate with health care providers to develop a treatment plan that aligns the child with the appropriate care services. ECC improves communication among health care providers, member, parent/guardian, systems, and agencies. ECC CM help to reduce duplication of efforts, ease transitions of care, limit gaps between service providers, and secure transportation or other support / enabling services.

Use your skills to make an impact
 

Required Qualifications:

Must meet one of the following requirements:

• Licensed Registered Nurse, (RN), in the state of Florida with no disciplinary action with a minimum of 2 years Pediatric acute care experience

• Licenses Practical Nurse, (LPN), in the state of Florida without disciplinary action with a minimum of 4 years Pediatric acute care experience

• Licensed Clinical Social Worker, (LCSW), with 1-year pediatric experience

Must meet all of the following requirements:

• Minimum 2 years complex care coordination, Enhanced Care Coordination (ECC)

• Intermediate or better working knowledge of Microsoft Office applications including Word, Excel, and Outlook

Additional Requirements / Adherence

Workstyle: Combination remote work at home and field based

Schedule: M-F 8:30 AM-5:00 PM coverage or overtime as business needs

Location:  Must reside within following regions/counties

• Region 1: Walton or Okaloosa

• Region 7: Seminole, Orange, Osceola, Brevard

Travel:

• This is a field-based role and requires the ability to meet with members weekly in their homes or facilities as needed to support business needs.

Transportation: This role is part of Humana’s Driver safety program and therefore requires:

• Possession of a valid driver's license and access to a reliable automobile

• Proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits. to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Work at Home Guidance To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office 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 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

TB and AHCA: This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program.

• If selected for this role, you will be required to be screened for TB.

• AHCA Fingerprint Required.

Preferred Qualifications

• A good understanding of AHCA regulations, NCQA and Medicaid guidelines

• Managed care experience

• Certified Case Manager (CCM)

• Bilingual Creole or Spanish

Additional Information

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice 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.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

#L1-Field

Scheduled Weekly Hours

40

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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.