Field Case Manager Los Angeles, CA Spanish CCM CDMS COHN CRRN
Registered nurse case manager job at Aetna
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness lifestyles and offer specialty programs here at Aetna.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Job Description
JOIN OUR GROWING TEAM
Are you tired of bedside nursing?
Are you looking to get away from 12-hour hospital shifts while continuing to utilize your RN expertise to impact the lives of patients in your local community?
We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Workers' Compensation Field Case Management team. This opportunity offers a competitive salary, full benefits, and a performance-based bonus paid out on a monthly or quarterly basis.
POSITION SUMMARY
Responsible for assessing and analyzing an injured employee to evaluate the medical and vocational needs required to facilitate the patients appropriate and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel.
Fundamental Components but not limited to the following:
Assesses and analyzes an injured employees medical and vocational status; develops a plan of care to facilitate the patients appropriate and timely return to work. Interviews patients in their homes, work-sites, or physicians office to provide ongoing case management services. Monitors patient progress toward desired outcomes through assessment and evaluation. Communicates both in-person and telephonically with patient, medical providers, attorneys, employers and insurance carriers; prepares all required documentation of case work activities. May arrange referrals, consultations and therapeutic services for patients; confers with specialists concerning course of care and treatment. Develops and administers educational and prevention programs. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Testifies as required to substantiate any relevant case work or reports. Daily travel in the field.
Qualifications
BACKGROUND/EXPERIENCE:
Registered Nurse (RN) with active state license in good standing in the state where job duties are performed required
Minimum 2 years clinical nursing background required
Bilingual Spanish Speaking Fluent preferred
Prior case management and workers' compensation experience preferred
Ability to multitask in a fast paced work environment
Strong computer skills with experience in Microsoft Office Products Excellent communication skills
EDUCATION
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Nursing/Certified Case Manager (CCM) is desired
Telework Specifications:
Full time WAH with daily travel in the field. Candidates should reside in the San Fernando Valley/Los Angeles area.
Additional Information
We offer you:
Autonomy
Productivity incentive
Home every night, weekend and holiday!
Schedule Monday-Friday
All major holidays are paid time off, vacation and sick time off is accrued. Full benefits offered including 401(k) and many corporate discounts available. Employees are reimbursed for fees to maintain licensure as well as free CEU's to maintain licensure
.
Continuing Education credits are available/provided for RN and a various industry certifications too
.
Work from home with in-state travel. In addition to annual salary, position has potential for a monthly monetary bonus. Mileage reimbursement is provided per the IRS rate.
Coventry provides laptop, IPhone, fax/scanner/printer, as well as office supplies.
Benefit eligibility may vary by position. Click
here
to review the benefits associated with this position.
All employees are expected to embody our values of
Excellence, Integrity, Caring and Inspiration
in all that they do as an employee. The overall responsibility of the Field Case Manager is to ensure the injured worker receives the best possible care in a timely and efficient manner towards full rehabilitation and return to work.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
Workers Compensation RN Field Case Manager Registered Nurse Spanish
Registered nurse case manager job at Aetna
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness lifestyles and offer specialty programs here at Aetna.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Job Description
JOIN OUR GROWING TEAM
Are you tired of bedside nursing?
Are you looking to get away from 12-hour hospital shifts while continuing to utilize your RN expertise to impact the lives of patients in your local community?
We are seeking self-motivated,energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Workers' Compensation Field Case Management team. This opportunity offers a competitive salary, full benefits, and a performance-based bonus paid out on a monthly or quarterly basis. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.
POSITION SUMMARY
Responsible for assessing and analyzing an injured employee to evaluate the medical and vocational needs required to facilitate the patients appropriate and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel.
Telework Specifications:
Full Time WAH EE with daily local travel in the field. Candidates should reside in the Sacramento, CA area and be bilingual - Spanish speaking.
Qualifications
BACKGROUND/EXPERIENCE:
2+ years clinical nursing background
Prior case management and workers' compensation experience preferred Ability to multitask in a fast paced work environment Strong computer skills with experience in Microsoft Office Products Excellent communication skills
Spanish is required
EDUCATION
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required Registered Nurse (RN) with active state license in good standing in the state where job duties are performed.
Nursing/Certified Case Manager (CCM) is preferred
FUNCTIONAL EXPERIENCES
Functional - Nursing/Critical Care/1-3 Years
Additional Information
ADDITIONAL JOB INFORMATION
Work Autonomously
No Weekend of Holiday
Meet top doctors of their specialty and learn from them directly
Earn CEU free by attending free seminars and in house training
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
As a Workers' Compensation Field Case Manager, you will be offered:
Autonomy
Productivity incentives
Monday-Friday schedule
Reimbursement for mileage, tolls, parking, licensure and certification
· Laptop, iPhone & printer/fax/scanner all in one.
Benefit eligibility may vary by position. Click
here
to review the benefits associated with this position.
Field Nurse Practitioner (Bakersfield, CA)
Bakersfield, CA jobs
Provides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nursing facilities and “pop up” clinics. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Provides general medical care and care coordination to various and/or specific patient member populations - adult, women's health, pediatric, and geriatric.
• Performs comprehensive evaluations including history and physical exams for gaps in care and preventive assessments.
• Addresses both chronic and acute primary care complaints, and demonstrates ability to ascertain medical urgency.
• Establishes and documents reasonable medical diagnoses.
• Seeks specialty consultation as appropriate.
• Orders/performs pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptoms; works within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately.
• Understands when a member's needs are beyond their scope of knowledge and when physician oversight is needed.
• Creates and implements a medical plan of care.
• Schedules appointments for visits when appropriate.
• Provides post-discharge coordination to reduce hospital readmission rates and emergency room utilization.
• Performs face-to-face in-person visits in a variety of settings including in-home, skilled nursing facilities, and public locations.
• Performs face-to-face visits via alternative modalities based on business need, leadership direction and state regulations.
• Orders bulk laboratory orders to target specific member populations.
• Performs alternating on-call coverage to triage any urgent lab results and pharmacy inquiries and develops appropriate plans of care.
• Participates in community-based “pop up clinics” to build relationships with communities, and address gaps in health care.
• Drives up to 120 miles a day on a regular basis to a variety of locations within the assigned region. Drives beyond 120 miles as part of extended mileage may be required on special project days. Special projects may include an overnight hotel stay.
• Obtains and maintains cross-state license in other states besides home state based on business need.
• Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and effectively.
• Actively participates in regional meetings.
• May prescribe medications and perform procedures as appropriate.
• Performs timely medical records documentation in electronic medical record (EMR) computer system.
• On occasion, may be required to walk flights of stairs while carrying up to 50 lbs. of equipment.
• Engages in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws.
• Local travel required (based upon state/contractual requirements).
Required Qualifications
• At least 1 year of experience as a nurse practitioner, or equivalent combination of relevant education and experience.
• Active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners (AANP) or American Nurses Credentialing Center (ANCC).
• Current state-issued license to practice as a Family Nurse Practitioner (FNP). License must be active and unrestricted in state of practice.
• Prescriber Drug Enforcement Agency (DEA) license with authority to prescribe per state qualifications. License must be active and unrestricted in state of practice.
• Current Basic Life Support (BLS) certification.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently with minimal supervision and demonstrate self-motivation.
• Responsive in all forms of communication.
• Ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills; ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency, and electronic medical record (EMR) experience.
Preferred Qualifications
• Experience as a registered nurse or nurse practitioner in a home health, community health or public health setting.
• Experience in home health as a licensed clinician, especially in management of chronic conditions.
• Experience with underserved populations facing socioeconomic barriers to health care.
• Immunization and point of care testing skills.
• Bilingual.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $101,721 - $198,356 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
RN Care Manager- La Crosse/Sparta
Remote
Become a part of our caring community and help us put health first Enjoy a rewarding career with a true work/life balance-no nights or weekends, giving you more time for what matters most. Humana is currently seeking RN Case Managers to join our teams in the La Crosse and Sparta offices, serving members in the Wisconsin Family Care (FC) program. In this vital role, you will collaborate with dedicated colleagues to ensure exceptional care coordination for our members, providing crucial support and education to help them thrive in their daily lives. Take the next step in your nursing career and make a meaningful difference with Humana.Key responsiblities:
Partner with a Care Coach (also referred to as a Case Manager), taking the lead on health-related needs, to collaborate on an ongoing basis regarding the member and their care plan.
Conduct regular health assessments for members and implement appropriate strategies and services to develop individualized care plans that support their continued health and safety.
Contribute to the creation, continuous evaluation, and coordination of the member's plan of care, including coordinating with outside providers to provide support with medication administration, assistance with home care, skilled nursing visits, and related services to ensure comprehensive care.
Contact and coordinate with acute and primary care providers.
Promote health and wellness through patient education on disease prevention, nutrition, exercise and lifestyle modifications.
Provide members with education and information about disease processes and related risks, supporting informed decision-making while respecting each individual's autonomy.
Daily documentation in member files within required DHS contract timeframes.
Participate in member monthly phone contacts and attend in person visits in members setting.
Traveling will be required and eligible for mileage reimbursement.
Use your skills to make an impact
Required Qualifications
Associate degree in nursing.
Must be a Registered Nurse, licensed in the state of Wisconsin in good standing.
Demonstrated intermediate computer proficiency, including experience with Microsoft Office applications.
Preferred Qualifications
Bachelor degree in nursing.
One (1)+ years of experience with Family Care target group: frail elders and adults with intellectual, developmental, or physical disabilities.
Care Management experience
Additional Information
Workstyle: 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.
Work Location: Either La Crosse WI or Sparta WI and surrounding area.
Travel: up to 40% throughout assigned area and surrounding areas
Typical Work Days/Hours: Monday through Friday, 8:00 am - 4:30 pm CST.
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees 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 employees 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.
Driving
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
TB
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Modern Hire
As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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.
SSN Alert
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
Auto-ApplyRN, Field Care Manager (Adults and Pediatrics)
Remote
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 performs primarily face to face and telephonic assessments to adult and pediatric members. The RN, Field Care Manager (Field Care Manager Nurse 2) 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. The RN, Field Care Manager (Field Care Manager, Nurse 2) understands professional concepts, regulations, strategies, and operating standards. They make decisions regarding work approach/priorities and follows direction.
Responsible for managing a case load and completing assessments with members in their home or community-based setting, as well as telephonically.
Provides clinical support and guidance, particularly for members with medical complexity.
Develops and coordinates care plans ensuring that patients receive appropriate services to manage their health needs effectively.
Addresses barriers to health care and advocating for optimal member outcomes.
Reviews, assesses, and completes medical complexity attestations and clinical oversights.
Ensures members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs.
Develops and modifies Individual Care Plan and involve applicable members of the care team in care planning (Informal caregiver, coach, PCP, etc.).
Focuses on supporting members and/or caregivers utilizing an interdisciplinary approach in accessing social, housing, educational and other services, regardless of funding sources to meet their needs.
Collaborates with Community Health Workers (CHW), Housing Specialist and other internal and external agencies for HRSN needs.
Primary point of contact for the ICT and shall be responsible for coordinating 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.
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Humana will provide Home or Hybrid Home/Office employees 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.
SSN Alert Statement
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
TB Screening
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Driving Statement
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
Auto-ApplyCare Manager, Telephonic RN
Remote
Become a part of our caring community and help us put health first The Compact licensed telephonic Care Manager works from home in a call center environment. They assess and evaluate members' needs and requirements to achieve or maintain optimal wellness by providing care coordination and facilitating member or family interaction with resources appropriate for the care and wellbeing of the member.
Job Description
Humana Care Support is a division of Humana dedicated to helping adults remain independent in their homes. Our nurses are called Care Managers, because our case management services are centered on the person rather than the condition. The Care Manager uses a range of strategies and techniques to manage a member's physical, environmental, and psycho-social health issues. They identify and resolve barriers to effective care and continuously monitor progress through assessments and evaluations to ensure members achieve their desired health outcomes.
Role Overview
The nature of the work requires telephonic interaction with members during the majority of the business day, primarily through an auto dialer system.
This role operates in a fast-paced environment, requiring the ability to quickly engage with members while navigating multiple computer applications simultaneously. To maintain compliance and support the auto-dialer process critical to our operations, care managers follow structured daily schedules, which limits day-to-day flexibility.
All our RN Care Managers are work at home associates, working from a dedicated home office space (see Work at Home Guidance below).
Remote Care Managers are expected to achieve established outcomes, quality, and productivity benchmarks and demonstrate advanced communication and interpersonal skills.
Duties Include
Telephonically working with Medicare members with transitional needs and complex chronic conditions.
Assessing members' physical, environmental, and psychosocial health needs, collaborating with a multidisciplinary team, and implementing timely clinical interventions to manage risks, coordinate care, and help prevent avoidable hospitalizations.
Collaboration with members who face multiple chronic conditions, along with financial and functional challenges, to support them in achieving and sustaining optimal health.
May develop individualized member care plans.
Success in this position requires that you
Understand department, segment, and organizational strategies and objectives, and how they connect to related areas.
Exercise judgement regarding own work methods, even in ambiguous situations, with minimal direction and occasional guidance where needed.
Demonstrate flexibility and ability to promptly adapt to new processes and workflows.
Adhere to established guidelines/procedures.
Use your skills to make an impact
Required Qualifications
Active Registered Nurse (R.N.) license with no disciplinary action on any license.
Must hold an active Compact nursing license and reside in the state that holds your compact license.
3+ years of clinical acute care experience with case management, discharge planning, and patient education for adult acute care
Demonstrated clinical expertise in managing chronic conditions through individualized care planning, supported by strong assessment and critical thinking skills
Proficiency in Microsoft Office applications including Word, Excel, and Outlook.
Demonstrated proficiency in navigating multiple systems using dual monitors, with strong computer skills and the ability to quickly learn new applications. Skilled in autonomous decision-making, troubleshooting, and problem-solving system-related issues
Preferred Qualifications
BSN or MSN degree
Case Management experience
Managed care experience
Certified Case Manager (CCM)
Bilingual in English and Spanish (see Language Proficiency Testing below)
Training and Work Schedule
The first 4 weeks of training work hours will be from 8:30AM to 5:00PM EST. No time off is permitted during the first month of training.
Following training, work hours are:
If you live in the Eastern Time Zone (EST): Work hours are 9:00 AM to 5:30 PM EST.
If you live in the Central Time Zone (CST): work hours are 10:00 AM to 6:30 PM EST
Work at Home Guidance
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is also required. Satellite, cellular and microwave connection is not allowed.
On occasion, the personal level of internet service a Home or Hybrid Home/Office associate provides-despite meeting the minimum requirement above-proves to be insufficient to maintain an optimal connection through Humana's VPN and thereby interferes with the Home or Hybrid Home/Office associate's ability to work effectively. When this happens, Humana reserves the right to require the associate to upgrade the level of his/her personal internet service as a condition of employment. Based on system requirements, you may need a download speed of up to 200 Mbps and an upload speed of 20 Mbps.
Employees 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 employees 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.
Language Proficiency Testing
Any Humana associate who wishes to communicate with members in a language other than English must complete a language proficiency assessment, administered by an approved external vendor, to ensure fluency and competency in that language Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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. Please note during the screening process, you will be asked to provide your Compact Nursing license number and your internet upload and download speeds from ****************** These items will be required prior to scheduling an interview.
Social Security Task
Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions to add the information into the application at Humana's secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
Auto-ApplyCare Coordinator, RN Field Based
Remote
Become a part of our caring community and help us put health first Humana Healthy Horizons in Indiana is seeking a Care Coordinator 2 (Field Care Manager 2) who assesses and evaluates member's 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. This position serves members of the new Indiana Medicaid program - Indiana PathWays for Aging (PathWays). The program was designed to help more Hoosiers who choose to age at home, do so, and to achieve better access to services, and better health and quality outcomes.
You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We are proud of our Louisville roots and, as we have grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are-whether you are working from home, from the field, from our offices, or from somewhere in between-you will feel welcome here. We are a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone's voice is heard and respected. Community is a verb here. It is up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.
* Health Insurance begins on day one!
* 23 days of vacation with pay per year
* Aggressive 401K program matching 125% of 6% after year one!
Are you caring, Curious and Committed? If so, apply today!
Position Responsibilities:
The Care Coordinator 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.
Facilitate the development of a longitudinal and trusting relationship with each member toward improved quality, continuity, and coordination of care.
Responsible for the coordination of all the member's needed medical and non-medical services, including functional, social, and environmental services.
Works collaboratively with the Service Coordinator, Transition Coordinator, and other care team staff to address the member's identified needs
Coordinates with all Medicare payers, Medicare Advantage plans, and Medicare providers as appropriate to coordinate the care and benefits of members who are also eligible for Medicare.
Primary point of contact for the Interdisciplinary Care Team (ICT) and shall be responsible for coordinating 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
Licensed Registered Nurse (RN) in the state of Indiana without restrictions
At least one (2) years of clinical experience as a nurse in providing case management or similar health care services (internal note: could be LPN experience if relevant)
Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook.
Exceptional communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.
Proven ability of critical thinking, organization, written and verbal communication and problem- solving skills.
Ability to manage multiple or competing priorities in a fast-paced environment.
Ability to use a variety of electronic information applications/software programs including electronic medical records.
Live/Reside in Indiana
Preferred Qualifications
Bilingual (English/Spanish) or (English/Burmese)
Prior nursing home diversion, long-term care, disease management, or case management experience
Prior management of Home and Community Based Services waivers (HCBS dual roles only)
Prior experience with Medicare & Medicaid recipients
Experience working with a geriatric population
Experience with health promotion, coaching and wellness
Knowledge of community health and social service agencies and additional community resources
Additional Information
About Humana
Your growth is what drives Humana forward.
When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we do not grow without you
This is a place where our nurses influence the C-suite.
Where software engineers change lives.
Where every associate can build a professional path where they learn and thrive.
Through our commitments to wellbeing and work-life balance, we support each associate's personal health, purpose, work style, sense of belonging, and security.
Because finding new ways to put health first-for our members and patients and our associates alike-is what we do.
Additional Requirements/Adherence
Workstyle: Combination remote work at home and onsite member visits
Location: Must reside in Indiana
Hours: Must be able to work a 40-hour work week, Monday through Friday 8:00 AM to 5:00 PM, over-time may be requested to meet business needs.
Travel: Must be willing to commute about 70% to meet with members.
On Call-Telephonic on call for an occasional night and/or weekend may be required.
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.
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.
Driver's License, Transportation, Insurance This role is a part of Humana's Driver Safety program and therefore requires and individual to have:
Valid state driver's license
Proof of personal vehicle liability insurance with at least $100,000/$300,000/$100,000 limits
Access to a reliable vehicle
Tuberculosis (TB) screening program
This role is considered patient facing and is part of Humana at Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
You will be able to respond to the recruiters preferred response method via text, video, or voice technologies. If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication is not missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
Auto-ApplyRN Care Manager
Long Beach, CA jobs
For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of South Carolina and or compact license. Care Manager RN will work with Medicaid/Medicare SC population completing assessments, care plans, educating, and connecting to community resources. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members and providers on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important.
Preferred experience working with a Behavioral Health population and/or Waiver program
Home office with internet connectivity of high speed required.
This is a remote position.
Schedule: Monday thru Friday 8:00AM to 5:00PM EST. (Flexibility to work 1 to 2 nights a week to 6 PM EST) (No Weekends or Holidays)
Job Summary
Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments.
• Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
• Conducts telephonic, face-to-face or home visits as required.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications
• At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA).
• Demonstrated knowledge of community resources.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and self-motivation.
• Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving, and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
Preferred Qualifications
• Certified Case Manager (CCM).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Auto-ApplyCare Manager RN (FIDE-SNP)
Long Beach, CA jobs
For this position we are seeking a (RN) Registered Nurse who must live and have a current active unrestricted RN license in the state of OH
Case Manager RN will work in remote and field setting supporting Medicare and Medicaid l health population. This role will be supporting our FIDE-SNP population, completing face to face assessments, care plans, and providing education and support to our members. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important.
Home office with internet connectivity of high speed required.
Schedule: Monday thru Friday 8:00AM to 5:00PM
Field Travel (Up to 50%) - Union, Delaware, Franklin, Madison, and Pickaway (Columbus OH). (Mileage is reimbursed)
JOB DESCRIPTION Job Summary
Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments.
• Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
• Conducts telephonic, face-to-face or home visits as required.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA).
• Demonstrated knowledge of community resources.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and self-motivation.
• Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving, and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
Preferred Qualifications
• Certified Case Manager (CCM).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Auto-ApplyRN Care Manager, LTSS field care in Brockton MA
Long Beach, CA jobs
The Care Manager, LTSS provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
This position will support our Moline One Care plan. Molina One Care is a community-based health care organization with national operations support delivering government funded health plans for members who reside in Massachusetts. We are looking for nurses with strong geriatric and chronic disease management experience, comprehensive assessment, person-centered care planning, and effective care coordination across interdisciplinary teams. Familiarity with Medicare/Medicaid integration, LTSS, and SCO regulations is a plus, Strong communication, documentation, EMR skills, and knowledge of community resources. Cultural competence, time management, and the ability to work independently. Previous SCO/ case management experience. Bilingual candidates that speak Cape Verdean Creole, Spanish, Haitian Creole are encouraged to apply to support our diverse communities!
Work Hours: Monday - Friday 8:00am - 5:00pm EST
Remote position with field travel in Brockton, Plymouth County, MA
Essential Job Duties
Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care.
• Assesses for medical necessity and authorizes all appropriate waiver services.
• Evaluates covered benefits and advises appropriately regarding funding sources.
• Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member health and welfare.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Ability to operate proactively and demonstrate detail-oriented work.
• Demonstrated knowledge of community resources.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
• In some states, must have at least one year of experience working directly with individuals with substance use disorders.
Preferred Qualifications
• Certified Case Manager (CCM).
• Experience working with populations that receive waiver services.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Auto-ApplyCare Manager RN - Waiver
Long Beach, CA jobs
For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO.
This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes.
TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed)
Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays
JOB DESCRIPTION Job Summary
Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care.
• Assesses for medical necessity and authorizes all appropriate waiver services.
• Evaluates covered benefits and advises appropriately regarding funding sources.
• Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member health and welfare.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Ability to operate proactively and demonstrate detail-oriented work.
• Demonstrated knowledge of community resources.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
• In some states, must have at least one year of experience working directly with individuals with substance use disorders.
Preferred Qualifications
• Certified Case Manager (CCM).
• Experience working with populations that receive waiver services.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Auto-ApplyField Nurse Practitioner (El Centro, CA)
El Centro, CA jobs
Provides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nursing facilities and “pop up” clinics. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Provides general medical care and care coordination to various and/or specific patient member populations - adult, women's health, pediatric, and geriatric.
• Performs comprehensive evaluations including history and physical exams for gaps in care and preventive assessments.
• Addresses both chronic and acute primary care complaints, and demonstrates ability to ascertain medical urgency.
• Establishes and documents reasonable medical diagnoses.
• Seeks specialty consultation as appropriate.
• Orders/performs pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptoms; works within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately.
• Understands when a member's needs are beyond their scope of knowledge and when physician oversight is needed.
• Creates and implements a medical plan of care.
• Schedules appointments for visits when appropriate.
• Provides post-discharge coordination to reduce hospital readmission rates and emergency room utilization.
• Performs face-to-face in-person visits in a variety of settings including in-home, skilled nursing facilities, and public locations.
• Performs face-to-face visits via alternative modalities based on business need, leadership direction and state regulations.
• Orders bulk laboratory orders to target specific member populations.
• Performs alternating on-call coverage to triage any urgent lab results and pharmacy inquiries and develops appropriate plans of care.
• Participates in community-based “pop up clinics” to build relationships with communities, and address gaps in health care.
• Drives up to 120 miles a day on a regular basis to a variety of locations within the assigned region. Drives beyond 120 miles as part of extended mileage may be required on special project days. Special projects may include an overnight hotel stay.
• Obtains and maintains cross-state license in other states besides home state based on business need.
• Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and effectively.
• Actively participates in regional meetings.
• May prescribe medications and perform procedures as appropriate.
• Performs timely medical records documentation in electronic medical record (EMR) computer system.
• On occasion, may be required to walk flights of stairs while carrying up to 50 lbs. of equipment.
• Engages in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws.
• Local travel required (based upon state/contractual requirements).
Required Qualifications
• At least 1 year of experience as a nurse practitioner, or equivalent combination of relevant education and experience.
• Active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners (AANP) or American Nurses Credentialing Center (ANCC).
• Current state-issued license to practice as a Family Nurse Practitioner (FNP). License must be active and unrestricted in state of practice.
• Prescriber Drug Enforcement Agency (DEA) license with authority to prescribe per state qualifications. License must be active and unrestricted in state of practice.
• Current Basic Life Support (BLS) certification.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently with minimal supervision and demonstrate self-motivation.
• Responsive in all forms of communication.
• Ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills; ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency, and electronic medical record (EMR) experience.
Preferred Qualifications
• Experience as a registered nurse or nurse practitioner in a home health, community health or public health setting.
• Experience in home health as a licensed clinician, especially in management of chronic conditions.
• Experience with underserved populations facing socioeconomic barriers to health care.
• Immunization and point of care testing skills.
• Bilingual.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $101,721 - $198,356 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
RN Transition of Care Coach Field Care in Richland, Pasco, or Kennewick
Long Beach, CA jobs
Provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings. Strives to ensure that best possible services are available to members at time of hospital discharge, and focuses on goal to reduce member readmissions. Contributes to overarching strategy to provide quality and cost-effective member care.
We are seeking a candidate with a WA state RN licensure. Candidates with case management and hospital- facility experience is highly preferred. Candidates must have a history of working with providers and members to provide care coordination, find resources, managing care needs, advocating, and assessing needs. Additional skills required strong communication skills, problem solving and must be organized. Bilingual candidates are encouraged to apply. Further details to be discussed during our interview process.
Remote with field travel to hospital facilities in the cities of Richland, Pasco, and Kennewick
Work schedule: Monday- Friday: 8:00am- 5:00pm PST.
RN WA licensure required
Essential Job Duties
• Follows member throughout a 30 day program that starts at hospital admission and continues oversight through transitions from acute setting to all other settings, including nursing facility placement/private home, with the goal of reduced readmissions.
• Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating with hospitalists, outpatient providers, facility staff, and family/support network.
• Ensures member transitions to setting with adequate caregiving and functional support, as well as medical and medication oversight support.
• Works with participating ancillary providers, public agencies or other service providers to make sure necessary services and equipment are in place for safe transition.
• Conducts face-to-face visits of all members while in the hospital and, home visits high-risk members post-discharge as needed.
• Coordinates care and reassesses member needs using the Coleman Care Transition model post-discharge.
• Educates and supports member focusing on seven primary areas (Transition of Care Pillars): medication management, use of personal health record, follow-up care, signs and symptoms of worsening condition, nutrition, functional needs and or home and community-based services, and advance directives.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
• Facilitates interdisciplinary care team meetings (ICT) and collaboration.
• Provides consultation, recommendations and education as appropriate to non-behavioral health care managers.
• 40-50% local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 2 years experience in health care, with at least 1 year of experience in hospital discharge planning, care management or behavioral health setting, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Knowledge of or experience using the Care Transitions Intervention (CTI) or similar model.
• Background in discharge planning and/or home health.
• Demonstrated knowledge of community resources.
• Proactive and detail-oriented.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving, and critical-thinking skills.
• Excellent verbal and written communication skills.
• Microsoft Office suite/other applicable software program(s) proficiency.
Preferred Qualifications
• Transitions of care sub-specialty certification and/or Certified Case Manager (CCM).
• Hospital discharge planning or home health experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Auto-ApplyHome Infusion Nurse - Accredo - Seattle, WA
Seattle, WA jobs
Home Infusion Registered Nurse - Accredo
Take your nursing skills to the next level by helping to improve lives with Accredo, the specialty pharmacy division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes.
As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it's about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You'll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team.
For more than 30 years, Accredo by Evernorth has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You'll get the opportunity to make a lasting impact on the lives of others.
How you'll make a difference and improve lives:
Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients' needs are met and to help them achieve their best health.
Administer Medications: Take full responsibility for administering IV infusion medications in patients' homes.
Provide follow-up care and manage responses to ensure their well-being.
Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey.
Requirements:
Active RN license in the state where you'll be working and living
2+ years of RN experience
1+ year of experience in critical care, acute care, or home healthcare
Strong skills in IV insertion
Valid driver's license
Willingness to travel to patients' homes within a large geographic region
Ability to work 40 hours a week (can include days, evenings, and weekends, per business need)
Flexibility to work different shifts on short notice and be available for on-call visits as needed
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 76,900 - 128,100 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Auto-ApplyRN Clinical Program Sr Advisor (Nurse Executive) - Multiple West Coast Locations - Hybrid
Sacramento, CA jobs
**EXPECTATIONS:** This role partners with the sales team and requires travel to client offices based on location. **GENERAL PURPOSE:** + Cigna's mission is to improve the health, well-being and sense of security for those we serve. The Clinical Sales and Network Organization, as Champions for affordable, predictable and simple health care, is dedicated to achievement of our Enterprise goals improving affordability and customer health outcomes, client growth and retention, and network performance.
**OVERVIEW:**
+ The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and Advocate, is closely aligned with Clients, Brokers, and other Key Stakeholders to promote improved healthcare quality and affordability for clients, members and communities we serve. This role executes on strategic priorities to meet enterprise targets related to Cigna Healthcare U.S. Sales Growth, Persistency and Total Medical Cost.
**RESPONSIBILITIES**
+ Stay current with healthcare industry trends and maintain a working knowledge of Cigna business segment strategies, clinical programs, services, and operational processes necessary to educate and provide consultative clinical insights to Sales, Clients, Brokers, and other key stakeholders.
+ Foster deep collaborative relationships with Sales, Sales Operations, Clients, and Brokers, championing Cigna's differentiated clinical value proposition.
+ Support achievement of business growth targets, including prospective review, request for proposal, finalist meetings, and new client onboarding.
+ Support achievement of business persistence targets, including medical cost driver analysis and action, complex case review, referral and engagement, account renewal consultation, and recommendations to positively impact medical cost trend, healthcare quality, and outcomes.
+ Collaborate and align across business units, working closely with Sales, clinical product and program teams, Marketing, Data and Analytics, Clinical Operations, Health Engagement, Evernorth Workplace Care, and others to design and deliver innovative client and market-specific solutions.
+ Participate in cross-functional projects at the local or national level, implementing actions that improve organizational or enterprise effectiveness and affordability.
+ In conjunction with Sales, Health Engagement, and others, facilitate Client and/or Broker external engagements (health forums, community and worksite events, educational presentations, corporate tours, etc.), promoting Cigna's integrated value proposition.
+ Respond to and facilitate resolution of escalated case inquiries, benefit and coverage explanations, and non-standard client benefit requests.
+ **Ideal candidate must reside in one of the following locations:** Glendale, CA; Irvine, CA; San Francisco Bay Area; Walnut Creek, CA; Seattle, WA; or Portland, OR.
**QUALIFICATIONS**
+ Active and unrestricted nursing license in your state of residence (required).
+ BSN is required
+ Advanced degree (preferred).
+ Minimum of three (3) years of clinical practice experience.
+ Proven industry experience in a health sector-related field (Health Insurance; Healthcare Professional and/or Delivery System Entities; Allied Health Industry; Pharmaceutical Sales; Medical Sales a plus).
+ Strong leadership, organizational, critical thinking, and execution skills.
+ Broad-based thinker with a solid understanding of overall approach to population health for employers.
+ Ability to work effectively in a matrixed environment.
+ Proven ability to foster, influence, and maintain collaborative, successful relationships with internal and external stakeholders.
+ Excellent oral and written communication skills.
+ Proficient in multiple forum presentations internally and externally.
+ Skilled in using Microsoft and technology/software applications.
+ Requires intermittent travel up to 50% of the time.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 116,200 - 193,600 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here (********************************************** .
**About Cigna Healthcare**
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
RN Clinical Program Sr Advisor (Nurse Executive) - Multiple West Coast Locations - Hybrid
San Francisco, CA jobs
**EXPECTATIONS:** This role partners with the sales team and requires travel to client offices based on location. **GENERAL PURPOSE:** + Cigna's mission is to improve the health, well-being and sense of security for those we serve. The Clinical Sales and Network Organization, as Champions for affordable, predictable and simple health care, is dedicated to achievement of our Enterprise goals improving affordability and customer health outcomes, client growth and retention, and network performance.
**OVERVIEW:**
+ The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and Advocate, is closely aligned with Clients, Brokers, and other Key Stakeholders to promote improved healthcare quality and affordability for clients, members and communities we serve. This role executes on strategic priorities to meet enterprise targets related to Cigna Healthcare U.S. Sales Growth, Persistency and Total Medical Cost.
**RESPONSIBILITIES**
+ Stay current with healthcare industry trends and maintain a working knowledge of Cigna business segment strategies, clinical programs, services, and operational processes necessary to educate and provide consultative clinical insights to Sales, Clients, Brokers, and other key stakeholders.
+ Foster deep collaborative relationships with Sales, Sales Operations, Clients, and Brokers, championing Cigna's differentiated clinical value proposition.
+ Support achievement of business growth targets, including prospective review, request for proposal, finalist meetings, and new client onboarding.
+ Support achievement of business persistence targets, including medical cost driver analysis and action, complex case review, referral and engagement, account renewal consultation, and recommendations to positively impact medical cost trend, healthcare quality, and outcomes.
+ Collaborate and align across business units, working closely with Sales, clinical product and program teams, Marketing, Data and Analytics, Clinical Operations, Health Engagement, Evernorth Workplace Care, and others to design and deliver innovative client and market-specific solutions.
+ Participate in cross-functional projects at the local or national level, implementing actions that improve organizational or enterprise effectiveness and affordability.
+ In conjunction with Sales, Health Engagement, and others, facilitate Client and/or Broker external engagements (health forums, community and worksite events, educational presentations, corporate tours, etc.), promoting Cigna's integrated value proposition.
+ Respond to and facilitate resolution of escalated case inquiries, benefit and coverage explanations, and non-standard client benefit requests.
+ **Ideal candidate must reside in one of the following locations:** Glendale, CA; Irvine, CA; San Francisco Bay Area; Walnut Creek, CA; Seattle, WA; or Portland, OR.
**QUALIFICATIONS**
+ Active and unrestricted nursing license in your state of residence (required).
+ BSN is required
+ Advanced degree (preferred).
+ Minimum of three (3) years of clinical practice experience.
+ Proven industry experience in a health sector-related field (Health Insurance; Healthcare Professional and/or Delivery System Entities; Allied Health Industry; Pharmaceutical Sales; Medical Sales a plus).
+ Strong leadership, organizational, critical thinking, and execution skills.
+ Broad-based thinker with a solid understanding of overall approach to population health for employers.
+ Ability to work effectively in a matrixed environment.
+ Proven ability to foster, influence, and maintain collaborative, successful relationships with internal and external stakeholders.
+ Excellent oral and written communication skills.
+ Proficient in multiple forum presentations internally and externally.
+ Skilled in using Microsoft and technology/software applications.
+ Requires intermittent travel up to 50% of the time.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 116,200 - 193,600 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here (********************************************** .
**About Cigna Healthcare**
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
RN Clinical Program Sr Advisor (Nurse Executive) - Multiple West Coast Locations - Hybrid
Walnut Creek, CA jobs
EXPECTATIONS: This role partners with the sales team and requires travel to client offices based on location.
GENERAL PURPOSE:
Cigna's mission is to improve the health, well-being and sense of security for those we serve. The Clinical Sales and Network Organization, as Champions for affordable, predictable and simple health care, is dedicated to achievement of our Enterprise goals improving affordability and customer health outcomes, client growth and retention, and network performance.
OVERVIEW:
The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and Advocate, is closely aligned with Clients, Brokers, and other Key Stakeholders to promote improved healthcare quality and affordability for clients, members and communities we serve. This role executes on strategic priorities to meet enterprise targets related to Cigna Healthcare U.S. Sales Growth, Persistency and Total Medical Cost.
RESPONSIBILITIES
Stay current with healthcare industry trends and maintain a working knowledge of Cigna business segment strategies, clinical programs, services, and operational processes necessary to educate and provide consultative clinical insights to Sales, Clients, Brokers, and other key stakeholders.
Foster deep collaborative relationships with Sales, Sales Operations, Clients, and Brokers, championing Cigna's differentiated clinical value proposition.
Support achievement of business growth targets, including prospective review, request for proposal, finalist meetings, and new client onboarding.
Support achievement of business persistence targets, including medical cost driver analysis and action, complex case review, referral and engagement, account renewal consultation, and recommendations to positively impact medical cost trend, healthcare quality, and outcomes.
Collaborate and align across business units, working closely with Sales, clinical product and program teams, Marketing, Data and Analytics, Clinical Operations, Health Engagement, Evernorth Workplace Care, and others to design and deliver innovative client and market-specific solutions.
Participate in cross-functional projects at the local or national level, implementing actions that improve organizational or enterprise effectiveness and affordability.
In conjunction with Sales, Health Engagement, and others, facilitate Client and/or Broker external engagements (health forums, community and worksite events, educational presentations, corporate tours, etc.), promoting Cigna's integrated value proposition.
Respond to and facilitate resolution of escalated case inquiries, benefit and coverage explanations, and non-standard client benefit requests.
Ideal candidate must reside in one of the following locations: Glendale, CA; Irvine, CA; San Francisco Bay Area; Walnut Creek, CA; Seattle, WA; or Portland, OR.
QUALIFICATIONS
Active and unrestricted nursing license in your state of residence (required).
BSN is required
Advanced degree (preferred).
Minimum of three (3) years of clinical practice experience.
Proven industry experience in a health sector-related field (Health Insurance; Healthcare Professional and/or Delivery System Entities; Allied Health Industry; Pharmaceutical Sales; Medical Sales a plus).
Strong leadership, organizational, critical thinking, and execution skills.
Broad-based thinker with a solid understanding of overall approach to population health for employers.
Ability to work effectively in a matrixed environment.
Proven ability to foster, influence, and maintain collaborative, successful relationships with internal and external stakeholders.
Excellent oral and written communication skills.
Proficient in multiple forum presentations internally and externally.
Skilled in using Microsoft and technology/software applications.
Requires intermittent travel up to 50% of the time.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 116,200 - 193,600 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Auto-ApplyRN Clinical Program Sr Advisor (Nurse Executive) - Multiple West Coast Locations - Hybrid
California jobs
EXPECTATIONS: This role partners with the sales team and requires travel to client offices based on location.
GENERAL PURPOSE:
Cigna's mission is to improve the health, well-being and sense of security for those we serve. The Clinical Sales and Network Organization, as Champions for affordable, predictable and simple health care, is dedicated to achievement of our Enterprise goals improving affordability and customer health outcomes, client growth and retention, and network performance.
OVERVIEW:
The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and Advocate, is closely aligned with Clients, Brokers, and other Key Stakeholders to promote improved healthcare quality and affordability for clients, members and communities we serve. This role executes on strategic priorities to meet enterprise targets related to Cigna Healthcare U.S. Sales Growth, Persistency and Total Medical Cost.
RESPONSIBILITIES
Stay current with healthcare industry trends and maintain a working knowledge of Cigna business segment strategies, clinical programs, services, and operational processes necessary to educate and provide consultative clinical insights to Sales, Clients, Brokers, and other key stakeholders.
Foster deep collaborative relationships with Sales, Sales Operations, Clients, and Brokers, championing Cigna's differentiated clinical value proposition.
Support achievement of business growth targets, including prospective review, request for proposal, finalist meetings, and new client onboarding.
Support achievement of business persistence targets, including medical cost driver analysis and action, complex case review, referral and engagement, account renewal consultation, and recommendations to positively impact medical cost trend, healthcare quality, and outcomes.
Collaborate and align across business units, working closely with Sales, clinical product and program teams, Marketing, Data and Analytics, Clinical Operations, Health Engagement, Evernorth Workplace Care, and others to design and deliver innovative client and market-specific solutions.
Participate in cross-functional projects at the local or national level, implementing actions that improve organizational or enterprise effectiveness and affordability.
In conjunction with Sales, Health Engagement, and others, facilitate Client and/or Broker external engagements (health forums, community and worksite events, educational presentations, corporate tours, etc.), promoting Cigna's integrated value proposition.
Respond to and facilitate resolution of escalated case inquiries, benefit and coverage explanations, and non-standard client benefit requests.
Ideal candidate must reside in one of the following locations: Glendale, CA; Irvine, CA; San Francisco Bay Area; Walnut Creek, CA; Seattle, WA; or Portland, OR.
QUALIFICATIONS
Active and unrestricted nursing license in your state of residence (required).
BSN is required
Advanced degree (preferred).
Minimum of three (3) years of clinical practice experience.
Proven industry experience in a health sector-related field (Health Insurance; Healthcare Professional and/or Delivery System Entities; Allied Health Industry; Pharmaceutical Sales; Medical Sales a plus).
Strong leadership, organizational, critical thinking, and execution skills.
Broad-based thinker with a solid understanding of overall approach to population health for employers.
Ability to work effectively in a matrixed environment.
Proven ability to foster, influence, and maintain collaborative, successful relationships with internal and external stakeholders.
Excellent oral and written communication skills.
Proficient in multiple forum presentations internally and externally.
Skilled in using Microsoft and technology/software applications.
Requires intermittent travel up to 50% of the time.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 116,200 - 193,600 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Auto-ApplyRegistered Nurse -Field Assessor
Sacramento, CA jobs
**Explore opportunities with Long Term Solutions,** a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of **Caring. Connecting. Growing together.**
As the Registered Nurse you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources.
**Primary Responsibilities:**
+ Provide high-quality clinical services within scope of practice and infection control standards
+ Coordinate care with other members of the patient/client's care team from admission to discharge
+ Complete clinical nursing assessments per federal/state program requirements and payer needs
+ Ensure patient/client eligibility and medical necessity for services as defined by payer and agency policy
+ Develop and revise individualized plans of care/service plans with other community providers
+ Ensure plan of care frequency and duration meets patient needs and initiate revisions with physician approval
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
**Required Qualifications:**
+ Current and unrestricted RN licensure in the state of practice
+ Current driver's license, vehicle insurance and access to a dependable vehicle or public transportation.
+ Current CPR certification
+ Demonstrated ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client
**State Specific Requirement:**
+ CA:
+ 1+ years of professional nursing
**Preferred Qualifications:**
+ 1+ years of RN experience
+ Demonstrated ability to work independently
+ Proven good communication, writing, and organizational skills
**Pay Range**
$64,100 - $141,500 annual total cash target pay
$36.98 - $81.63 per visit point
$30.82 - $68.03 hourly rate
Annual total cash compensation for this role assumes full-time employment (40 weekly hours) at full productivity and generally follows the range above. Total cash compensation includes earnings from per visit point pay and hourly pay and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. This role receives two types of compensation depending on the work being performed. When conducting visits, you will be paid per visit point rate compensation. Your per visit pay will be calculated by multiplying your per visit point rate by the productivity points you accrue for various types of visits. Each type of visit is assigned a certain number of productivity points that is inclusive of "direct" and "indirect" patient care activities. Visits are assigned based on patient and business needs. The number of visits performed each week will vary based on individual productivity targets and the productivity points assigned to the visits performed. You will be paid your hourly rate for certain non-visit activities such as orientation. We comply with all minimum wage laws as applicable. In addition to your pay, we offer benefits such as, a comprehensive benefits package, recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
Registered Nurse - Field Assessor
Palmdale, CA jobs
**Explore opportunities with Long Term Solutions,** a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of **Caring. Connecting. Growing together.**
As the Registered Nurse you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources.
**Primary Responsibilities:**
+ Provide high-quality clinical services within scope of practice and infection control standards
+ Coordinate care with other members of the patient/client's care team from admission to discharge
+ Complete clinical nursing assessments per federal/state program requirements and payer needs
+ Ensure patient/client eligibility and medical necessity for services as defined by payer and agency policy
+ Develop and revise individualized plans of care/service plans with other community providers
+ Ensure plan of care frequency and duration meets patient needs and initiate revisions with physician approval
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
**Required Qualifications:**
+ Current and unrestricted RN licensure in the state of practice
+ Current driver's license, vehicle insurance and access to a dependable vehicle or public transportation.
+ Current CPR certification
+ Demonstrated ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client
**State Specific Requirement:**
+ CA:
+ 1+ years of professional nursing
**Preferred Qualifications:**
+ 1+ years of RN experience
+ Demonstrated ability to work independently
+ Proven good communication, writing, and organizational skills
**Pay Range**
$64,100 - $141,500 annual total cash target pay
$36.98 - $81.63 per visit point
$30.82 - $68.03 hourly rate
Annual total cash compensation for this role assumes full-time employment (40 weekly hours) at full productivity and generally follows the range above. Total cash compensation includes earnings from per visit point pay and hourly pay and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. This role receives two types of compensation depending on the work being performed. When conducting visits, you will be paid per visit point rate compensation. Your per visit pay will be calculated by multiplying your per visit point rate by the productivity points you accrue for various types of visits. Each type of visit is assigned a certain number of productivity points that is inclusive of "direct" and "indirect" patient care activities. Visits are assigned based on patient and business needs. The number of visits performed each week will vary based on individual productivity targets and the productivity points assigned to the visits performed. You will be paid your hourly rate for certain non-visit activities such as orientation. We comply with all minimum wage laws as applicable. In addition to your pay, we offer benefits such as, a comprehensive benefits package, recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._