Job DescriptionCLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
90% of time will be spent on one or more of the following activities depending on assignments:
Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization:
Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations.
Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care.
Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns.
May develop recommendations for further corrective action based on medical review findings.
May refer for review, or implement, corrective action related to medical review activities.
May process claims and complete project work in the appropriate computer system(s).
The remaining 10% of time will be spent on the following activities depending on assignments:
Identify providers needing education and individually educate providers who are subject to medical
review processes:
Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal.
This may involve discussion with CMS leaders and leaders in the provider community.
Participate in special projects as assigned.
REQUIRED QUALIFICATIONS
* Valid nursing degree
* 2 years' clinical experience
* Excellent written and oral communication skills
* Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility)
* Strong computer skills to include Microsoft Office proficiency
* Valid unrestricted RegisteredNurse (RN) license
PREFERRED QUALIFICATIONS
* Inpatient Rehabilitation Facility Experience
* Bachelor of Science in Nursing (BSN)
* Insurance industry experience
* Certified Coder
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.
$48k-67k yearly est. 6d ago
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Senior Stars Improvement, Clinical Professional BSN/RN
Humana 4.8
Remote
Become a part of our caring community and help us put health first The Senior Stars Improvement, Clinical Professional responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Senior Stars Improvement, Clinical Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Stars Improvement, Clinical Professional is responsible for a provider assignment of 50+ Medicaid provider groups. This position oversees HEDIS, quality & performance improvement and required quality activities that are related to NCQA health plan performance rating as well as the Agency's Quality Withhold and Liquidated Damages programs for assigned providers. Also supports improvement strategies through engagement with internal and external stakeholders.
The Senior Stars Improvement, Clinical Professional monitors assigned value-based and non-value-based provider/provider groups' performance in key performance indicators related to preventive care, care of chronic conditions and identified medical metrics (ex. HEDIS, APT, readmissions, ED utilization, polypharmacy, etc.). In this role, you will actively engage providers, review of KPIs, improvement strategies and bi-directional feedback related to barriers and opportunities. Educate and assist providers in reducing potential preventable events through the use of data driven methods and resources related to available clinical programs. Support improvement in member experience through education, information and resources related to the annual Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and Humana's Member Experience Medicaid Survey (MEMS).
Responsibilities:
Continue to focus efforts and identify opportunities on performance improvement for assigned providers
Actively engages provider during virtual visit to facilitate education, HEDIS outcomes, care of members and bi-directional feedback.
Attends JOCs with providers and participates in active discussions on HEDIS, member care, and clinical/quality outcomes.
Communicate clinical quality initiatives to assigned providers
Educate and assist providers in reducing potential preventable events
Educate providers and staff about Medicaid Consume Assessment of Healthcare Providers and Systems (CAHPS) survey.
Use your skills to make an impact
Required Qualifications
FL RN License
Must reside in the state of Florida
Must have two years of prior HEDIS, STARS and/or quality improvement experience in Medicaid or Medicare (Medicaid quality improvement a plus).
Proficient/ intermediate utilization of Excel and PowerPoint.
Prior experience in a fast-paced insurance or health care setting
Experience collaborating with cross-functional teams
Proven analytical skills
Excellent communication skills, both oral and written
Strong relationship building skills
Conducts self in a professional manner with all verbal and written communication when working with associates, peers, and providers
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred
FL BSN License (Bachelor's Degree in Nursing)
Medical Coding Certification
Knowledge of Humana's internal policies, procedures, and systems
Medicaid Health Plan Experience
Additional Information
Workstyle: Remote
Work Location: Must reside in FL
Travel: None
Typical Workdays/Hours: Monday- Friday, 8am- 5pm EST
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format
As part of our hiring process for this opportunity, we will be using exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first-round interview, you will receive an email correspondence inviting you to participate in a HireVue interview. In this interview, you will receive a set of interview questions over your phone, and you will provide recorded or text message responses to each question.
For best interview experience use a computer over a phone.
You should anticipate this interview to take about 15-20 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Humana Benefits
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
Health benefits effective day 1
Paid time off, holidays, volunteer time and jury duty pay
Recognition pay
401(k) retirement savings plan with employer match
Tuition assistance
Scholarships for eligible dependents
Parental and caregiver leave
Employee charity matching program
Network Resource Groups (NRGs)
Career development opportunities
Social Security Task
Humana value's 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.
$78,400 - $107,800 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.
$78.4k-107.8k yearly Auto-Apply 5d ago
Senior Stars Improvement, Clinical Professional RN
Humana 4.8
Remote
Become a part of our caring community and help us put health first The Senior Stars Improvement, Clinical Professional responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Senior Stars Improvement, Clinical Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Stars Improvement Clinical Professional focused on maternal health is responsible for a provider assignment of 50+ Medicaid provider groups. This position oversees HEDIS, quality & performance improvement and required quality activities that are related to NCQA health plan performance rating as well as the Agency's Quality Withhold and Liquidated Damages programs for assigned providers. Also supports improvement strategies through engagement with internal and external stakeholders.
The Senior Stars Improvement, Clinical Professional monitors assigned value-based and non-value-based provider/provider groups' performance in key performance indicators which may include preventive care, maternal health, and identified medical metrics (ex. HEDIS, admissions, readmissions, ED utilization, polypharmacy, pre-term delivery rate, cesarean section rate, etc.). In this role, you will actively engage providers, review KPIs, improvement strategies and bi-directional feedback related to barriers and opportunities. Educate and assist providers in reducing potential preventable events through the use of data driven methods and resources related to available clinical programs. Support improvement in member experience through education, information and resources related to the annual Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and Humana's Member Experience Medicaid Survey (MEMS).
The Senior Stars Improvement, Clinical Professional will collaborate with internal stakeholders and leaders to analyze and inform strategies for improvement in maternal health outcomes for our members and the communities we serve.
Responsibilities:
Continue to focus efforts and identify opportunities on performance improvement for assigned providers
Actively engages provider during routine virtual visits to facilitate education, HEDIS and medical metric outcomes, care of members and bi-directional feedback.
Attends joint operating committee meetings (JOCs) with providers and participates in active discussions on HEDIS, member care, and clinical/quality outcomes.
Communicate clinical quality initiatives to assigned providers
Educate and assist providers in developing strategies to reduce potential preventable events
Educate providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
Actively engage with internal stakeholders, leaders and teams to analyze and inform improvement strategies to address maternal health outcomes. Engagement may include formal and informal discussions, in individual or group settings.
Use your skills to make an impact
Required Qualifications
FL RN License
Must reside in the state of Florida
Must have quality improvement experience in Medicaid or Medicare (Medicaid quality improvement a plus) (i.e. HEDIS, CMS Stars)
Proficient/ intermediate utilization of Excel and PowerPoint.
Prior experience in a fast-paced insurance or health care setting
Experience collaborating with cross-functional teams
Proven analytical skills
Excellent communication skills, both oral and written
Strong relationship building skills
Demonstrated ability to work independently, proactively initiate tasks, conduct thorough research, and acquire new knowledge to support ongoing development.
Conducts self in a professional manner with all verbal and written communication when working with associates, peers, and providers
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Bachelor's degree in nursing or related field
Medical Coding Certification
Certified Professional in Healthcare Quality (CPHQ)
Knowledge of Humana's internal policies, procedures, and systems
Medicaid Health Plan Experience
Additional Information
Workstyle: Remote
Work Location: Must reside in FL
Travel: None
Typical Workdays/Hours: Monday- Friday, 8am- 5pm EST
Work-At-Home Requirements:
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format:
As part of our hiring process for this opportunity, we will be using exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first-round interview, you will receive an email correspondence inviting you to participate in a HireVue interview. In this interview, you will receive a set of interview questions you may answer via by phone or computer, and you will provide recorded or text message responses to each question. Some of the questions may require longer responses and using a computer vs phone to type responses may work best. You should anticipate this interview to take about 15-20 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Why Humana?
At Humana, we know your well-being is important to you, and it's important to us too. That's why we're committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. Just to name a few:
Work-Life Balance
Generous PTO package
Health benefits effective day 1
Annual Incentive Plan
401K - with company match
Well-being program
Paid Volunteer Time Off
Student Loan Refinancing
If you share our passion for helping people, we likely have the right place for you at Humana.
Social Security Task:
Alert: Humana values personal identity protection. Please be aware that applicants being considered for an offer 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.
$78,400 - $107,800 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.
$78.4k-107.8k yearly Auto-Apply 5d ago
Care Coordinator, RN Field Based
Humana 4.8
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 RegisteredNurse (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.
$71.1k-97.8k yearly Auto-Apply 12d ago
Maternity Care Management Field Nurse
Humana 4.8
Remote
Become a part of our caring community and help us put health first The Field Care Manager Nurse 2 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. The Field Care Manager Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Maternity Field Care Management Nurse (Field Care Manager Nurse) 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. The Field Care Manager Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
We have a position available in Region 6, 7, or 8 in Louisiana.
Position Responsibilities:
The Field Care Manager 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.
Uses a holistic, member-focused approach to engage members and families in recovery and wellness programs
Conducts telephonic and in-person assessments to identify member needs and guide to appropriate resources
Supports optimal health and wellbeing through regular monitoring and evaluation of progress
Develops individualized care plans using clinical judgment and changes in health status
Collaborates with providers and community services to ensure quality, cost-effective outcomes
Coordinates services for physical health, social determinants of health, and additional benefits
Facilitates communication across the care team, including PCP and care transitions
Provides relevant resources to families for health and wellness support
Submits incident reports as required
Participates in health promotion and community events
Use your skills to make an impact
Required Qualifications
Licensed RegisteredNurse (RN) in the state of Louisiana without restrictions
Minimum two (2) years of clinical experience in maternity, Labor & Delivery, L&D, maternal child
Intermediate to advanced computer skills and experience with Microsoft Word, Outlook, and Excel
Ability to use a variety of electronic information applications/software programs including electronic medical records
Exceptional communication and interpersonal skills with the ability to quickly build rapport
Ability to work with minimal supervision within the role and scope with the ability to adapt care plan to change in member status
Preferred Qualifications
Case Management Certification (CCM) or willingness to obtain within two (2) years of employment
Understanding of the current state Maternal/Child Mortality Morbidity
Basic Breastfeeding knowledge
Experience working with Medicare, Medicaid and dual-eligible populations
Field Case Management Experience
Health Plan experience
Knowledge of community health and social service agencies and additional community resources
Experience with health promotion, coaching and wellness
Motivational Interviewing experience
Work-At-Home Requirements
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 required
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Workstyle: Combination remote work at home and onsite/home member visits
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 and requires approval.
Travel: Must be willing to travel for field visits to meet with members in your Region, based on member tier level (to be explained during the interview)
Positions available in the following Parishes:
Region 6: Grant, LaSalle, Catahoula, Concordia, Avoyelles, Vernon, Winn, Rapides
Region7: Webster, Claiborne, Caddo, Sabine, Natchitoches, Red River, Bossier, Bienville, Desoto
Region 8: Union, Jackson, Morehouse, West Carroll, East Carroll, Madison, Richland, Tensas, Franklin, Ouachita Lincoln, Caldwell
Driver's License, Transportation, Insurance This role is a part of Humana's Driver Safety program and therefore requires and individual to have a valid state driver's license proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits, and access to a reliable vehicle
Additional Information
Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH's Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)
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.
$71.1k-97.8k yearly Auto-Apply 12d ago
Utilization Management Nurse - Home Solutions - Compact RN Required
Humana 4.8
Remote
Become a part of our caring community and help us put health first Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require
interpretation and independent determination of the appropriate courses of action.
As a Utilization Management RN working on the OneHome/Home Solutions UM Team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal at home.
In this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.
The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Success in this role requires the following:
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Excellent organizational and time management skills
Solid analytical skills to understand and interpret clinical information to make recommendations to improve patient outcomes.
Technical savvy and ability to navigate multiple systems and screens while working cases.
Collaboration skills to effectively interact with multiple parties both internal and external.
An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed.
Ability to follow established guidelines, processes, and procedures.
Use your skills to make an impact
Shift is Monday - Friday 8:00am - 5:00pm Eastern Standard Time
Required Qualifications
Minimum of Associate Degree in nursing
Licensed RegisteredNurse (RN) in a compact state with no disciplinary action.
Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population
Effective telephonic and virtual communication skills• Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and within a team.
Preferred Qualifications
Bachelor's degree
Two (2) or more years of home health experience and/or utilization management experience
Experience in a managed care setting
Health Plan experience
CGX experience
Work-At-Home Requirements
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.
Check your internet speed at ****************** A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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.
$71.1k-97.8k yearly Auto-Apply 9d ago
SNF Utilization Management RN - Compact Rqd
Humana 4.8
Remote
Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Use your skills to make an impact
Use your skills to make an impact
Required Qualifications
Licensed RegisteredNurse (RN) in the (appropriate state) with no disciplinary action.
MUST have Compact License
Greater than one year of clinical experience in a RN role in acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc.
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and with a team
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Education: BSN or Bachelor's degree in a related field
Three or more years of clinical experience in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc.
Experience as an MDS Coordinator or discharge planner in an acute care setting
Previous experience in utilization management/utilization review for a health plan or acute care setting
Compact license PLUS a single state RN Licensure in any of the following non-compact states: California, Hawaii, Nevada, Oregon
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Bilingual is a plus
Additional Information
Scheduled Weekly Hours: 40
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Work-At-Home Requirements
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.
Check your internet speed at *****************
A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.
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
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 OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. OneHome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.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.
$71.1k-97.8k yearly Auto-Apply 60d+ ago
RN, Field Care Manager (Adults and Pediatrics)
Humana 4.8
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 RegisteredNurse (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.
$71.1k-97.8k yearly Auto-Apply 49d ago
RN Care Manager- La Crosse/Sparta
Humana 4.8
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 RegisteredNurse, 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.
$71.1k-97.8k yearly Auto-Apply 35d ago
Bilingual RN- Telephonic Care Management
Humana 4.8
Remote
Become a part of our caring community and help us put health first This is a Work-At-Home position located in Puerto Rico. You must live in Puerto Rico for this position. The RN Care Manager works in a telephonic environment. They assess and evaluate members' needs and requirements to achieve and maintain an optimal wellness state. Using clinical knowledge, the Care Manager guides members with chronic conditions toward and facilitates interaction with resources appropriate for their care and wellbeing. The Care Manager, Telephonic Nurse's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
You must be fully bilingual in English/Spanish and will be required to pass a test for both languages - Speaking/Reading/Writing included. ***Please submit resume in English.
The Care Manager, Telephonic Nurse employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Responsibilities include the following:
Identifies and resolves barriers that hinder effective care.
Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations.
May create member care plans.
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Use your skills to make an impact
Required Qualifications
Bachelor's Degree in Nursing (BSN)
Bilingual in English and Spanish (and able to pass language proficiency tests in both languages)
Active RN license without restrictions in Puerto Rico
Active RN license without restrictions in Florida - if you DO NOT have an active FL RN license, you must have already passed the NCLEX exam.
Affiliated with the CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico).
Prior clinical experience in adult acute care, skilled nursing, rehabilitation or discharge planning
Knowledge in Chronic Condition management (treatment, pharmacological treatment, signs & symptoms, etc.) Diabetes, Hypertension, COPD, Chronic Kidney Disease, etc.
Ability to work independently under minimum supervision and with a team.
Able to work an 8-hour shift between 8:30 AM - 5:30 PM EST and adjusted for Daylight Savings
(Work schedule can be adjusted according to business hours - necessary overtime and/or weekends)
Preferred Qualifications
Health Plan experience
Previous Case Management Experience
Call center or triage experience
Previous experience managing Medicare members
Work-At-Home Requirements
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 Work-At-Home 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 speaks with a member in a language other than Spanish 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.
Additional Information
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.
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.
$56,900 - $78,200 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.
$56.9k-78.2k yearly Auto-Apply 14d ago
Registered Nurse, Home Health
Humana Inc. 4.8
Marion, OH jobs
Become a part of our caring community and help us put health first Make a meaningful impact every day as a CenterWell Home Health nurse. You'll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you'll develop and manage care plans that support recovery and help patients get back to the life they love.
As a Home Health RegisteredNurse, you will:
* Provide admission, case management, and follow-up skilled nursing visits for home health patients.
* Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager.
* Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation.
* Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides and external providers).
* Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis.
* Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems.
* Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflect current plan of care. Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility.
* Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation.
* Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records, and confers with other health care disciplines in providing optimum patient care.
Use your skills to make an impact
Required Experience/Skills:
* Diploma, Associate or Bachelor Degree in Nursing
* Minimum of one year nursing experience preferred
* Strong med surg, ICU, ER, acute experience
* Home Health experience a plus
* Current and unrestricted RegisteredNurse licensure
* Current CPR certification
* Strong organizational and communication skills
* Valid driver's license, auto insurance and reliable transportation.
Scheduled Weekly Hours
1
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.
$77,200 - $106,200 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident.
About Us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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.
$77.2k-106.2k yearly 5d ago
Registered Nurse, Home Health
Humana Inc. 4.8
Upper Sandusky, OH jobs
Become a part of our caring community and help us put health first Make a meaningful impact every day as a CenterWell Home Health nurse. You'll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you'll develop and manage care plans that support recovery and help patients get back to the life they love.
As a Home Health RegisteredNurse, you will:
* Provide admission, case management, and follow-up skilled nursing visits for home health patients.
* Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager.
* Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation.
* Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides and external providers).
* Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis.
* Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems.
* Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflect current plan of care. Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility.
* Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation.
* Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records, and confers with other health care disciplines in providing optimum patient care.
Use your skills to make an impact
Required Experience/Skills:
* Diploma, Associate or Bachelor Degree in Nursing
* Minimum of one year nursing experience preferred
* Strong med surg, ICU, ER, acute experience
* Home Health experience a plus
* Current and unrestricted RegisteredNurse licensure
* Current CPR certification
* Strong organizational and communication skills
* Valid driver's license, auto insurance and reliable transportation.
Pay Range
* $45.00 - $63.00 - pay per visit/unit
* $70,500 - $96,900 per year base pay
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.
$77,200 - $106,200 per year
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 CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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.
$77.2k-106.2k yearly 57d ago
SNF Utilization Management RN - Compact Rqd
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
**Use your skills to make an impact**
**Use your skills to make an impact**
**Required Qualifications**
+ ** Licensed RegisteredNurse (RN)** in the (appropriate state) with no disciplinary action.
+ **MUST have Compact License**
+ Greater than one year of clinical experience in a RN role in acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc.
+ Comprehensive knowledge of Microsoft Word, Outlook and Excel
+ Ability to work independently under general instructions and with a team
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Education: BSN or Bachelor's degree in a related field
+ Three or more years of clinical experience in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc.
+ Experience as an MDS Coordinator or discharge planner in an acute care setting
+ Previous experience in utilization management/utilization review for a health plan or acute care setting
+ Compact license PLUS a single state RN Licensure in any of the following non-compact states: California, Hawaii, Nevada, Oregon
+ Health Plan experience
+ Previous Medicare/Medicaid Experience a plus
+ Call center or triage experience
+ Bilingual is a plus
**Additional Information**
+ Scheduled Weekly Hours: 40
+ Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Work-At-Home Requirements**
+ Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
+ A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.
+ Check your internet speed at *****************
+ A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.
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
**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 OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. OneHome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.
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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$71.1k-97.8k yearly 60d+ ago
Registered Nurse, Home Health
Humana Inc. 4.8
Solon, OH jobs
Become a part of our caring community and help us put health first Make a meaningful impact every day as a CenterWell Home Health nurse. You'll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you'll develop and manage care plans that support recovery and help patients get back to the life they love.
As a Home Health RegisteredNurse, you will:
* Provide admission, case management, and follow-up skilled nursing visits for home health patients.
* Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager.
* Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation.
* Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides and external providers).
* Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis.
* Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems.
* Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflect current plan of care. Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility.
* Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation.
* Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records, and confers with other health care disciplines in providing optimum patient care.
Use your skills to make an impact
Required Experience/Skills:
* Diploma, Associate or Bachelor Degree in Nursing
* Minimum of one year nursing experience preferred
* Strong med surg, ICU, ER, acute experience
* Home Health experience a plus
* Current and unrestricted RegisteredNurse licensure
* Current CPR certification
* Strong organizational and communication skills
* Valid driver's license, auto insurance and reliable transportation.
Pay Range
* $45.00 - $63.00 - pay per visit/unit
* $70,500 - $96,900 per year base pay
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.
$77,200 - $106,200 per year
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 CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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.
$77.2k-106.2k yearly 12d ago
Pre-Authorization Nurse 2
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Pre-Authorization Nurse 2 completes medical necessity and level of care reviews for requested services using clinical judgment, and refers to internal stakeholders for review depending on case findings. Educates providers on utilization and medical management processes. Enters and maintains pertinent clinical information in various medical management systems. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
**Use your skills to make an impact**
**Required Qualifications**
+ 2+ years Utilization Management experience
+ Active RN license in the state(s) in which the nurse is required to practice
+ Ability to be licensed in multiple states without restrictions
+ A minimum of three years varied nursing experience
+ Previous experience in utilization management, case management, discharge planning and/or home health or rehab
+ Proficient with MS Office products including Word, Excel and Outlook
+ Ability to work independently under general instructions and with a team
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Bachelor's degree
+ Health Plan experience working with large carriers
+ Previous Medicare/Medicaid experience a plus
+ Outpatient or home health experience in Utilization Management
+ Experience working with MCG or Interqual guidelines
**Additional Information**
+ **Schedule** : Monday through Friday, 8:00 AM - 5:00 PM with flexibility to work overtime/weekend as needed.
+ **Work Location:** US Nationwide
+ **Work Style:** Remote
+ **Travel Requirements** **: Less than 1%**
**Work-at-Home (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.
**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.
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.
Application Deadline: 01-19-2026
**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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$71.1k-97.8k yearly 4d ago
Home Health Licensed Practical Nurse
Humana 4.8
Miami Heights, OH jobs
Become a part of our caring community and help us put health first The Home Health Nursing, LPN/LVN enables patients to stay in their homes by providing health and personal services; supporting patients and their families. The Home Health Nursing, LPN/LVN work assignments are often straightforward and of moderate complexity.
The Home Health Nursing, LPN/LVN assesses and records patient condition by monitoring vital signs. Administers treatments by dispensing medications; changing bandages; administering oxygen supply and equipment. Helps patients care for themselves and helps family members care for the patient by introducing and teaching assisted living techniques such as using a cane or walker, using special utensils to eat, using special techniques and equipment for personal hygiene needs, and appropriate ways to lift, turn, and re-position the patient. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
Use your skills to make an impact
Required Qualifications
Licensed Practical Nurse license in the State of Florida
CPR certification
OSHA Certificate
HIV/AIDS Certificate
HIPAA Certificate
Alzheimer's Certificate
Medical Errors Certificate
Domestic Violence Certificate
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.
Must have a valid in-state driver's license, provide current registration and insurance, and have a driving record with no more than 2 points within the last 3 years.
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 100,000/300,000/100,000 limits.
Scheduled Weekly Hours
1
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.
$53,000 - $73,000 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident.
About Us
About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. OneHome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.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.
$53k-73k yearly Auto-Apply 49d ago
Licensed Practical Nurse, Home Health
Humana Inc. 4.8
Solon, OH jobs
Become a part of our caring community and help us put health first Make a meaningful impact every day as a CenterWell Home Health nurse. You'll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you'll develop and manage care plans that support recovery and help patients get back to the life they love.
As a Home Health LPN, you will:
* Provide professional nursing services under the direction of a RN in compliance with the state's Nurse Practice Act, any applicable licensure/certification requirement, applicable healthcare standards, governmental laws and regulations, and CenterWell Home Health policies and procedures.
* Provide skilled nursing interventions in the treatment of the patient/clients illness, rehabilitative needs and preventative care. Utilize a holistic approach in the provision of problem specific therapeutic interventions, teaching and training activities in accordance with the plan of care.
* Apply knowledge and skills in accordance with accepted standards of clinical practice to facilitate problem resolution and achieve individualized patient goals and outcomes.
* Confer with the RN Supervisor regarding needed changes in the Plan of Treatment. Accept verbal orders from physician were permitted by state law/regulations/Nurse Practice Act and communicate these orders to the RN Supervisor.
* Utilize a systematic, individualized goal/outcome driven approach in implementing the nursing plan of care.
* Maintain contact with patients, physicians, clinical manager(s), other members of the healthcare team in a timely manner regarding patient/family needs and status changes. Participate in care coordination activities and discharge planning as appropriate.
* Maintain the highest standards of professional conduct in relation to information that is confidential in nature. Share information only when the recipient's right to access is clearly established and the sharing of such information is dearly in the best interests of the patient.
* Appropriately communicate to ensure adherence to professional standards in the provision of and availability of supplies, materials and equipment needed to safely and effectively implement the plan of care.
* Prepare, submit and maintain documentation as required by the Company and/or facility. Visit/shift notes documented on day services are rendered.
Use your skills to make an impact
Required Experience/Skills:
* Graduate of an accredited Licensed Practical Nursing Program or accredited School of Vocational Nursing.
* Current nursing license in the practicing state.
* Valid drivers license, auto insurance and reliable transportation.
* Current CPR certification.
* Two years experience as an LPN/LVN in a clinical setting, preferably in a home health or hospice setting.
Scheduled Weekly Hours
28
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.
$53,000 - $73,000 per year
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 CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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.
$53k-73k yearly 5d ago
Registered Nurse, Home Health
Humana Inc. 4.8
Kenton, OH jobs
Become a part of our caring community and help us put health first Make a meaningful impact every day as a CenterWell Home Health nurse. You'll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you'll develop and manage care plans that support recovery and help patients get back to the life they love.
As a Home Health RegisteredNurse, you will:
* Provide admission, case management, and follow-up skilled nursing visits for home health patients.
* Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager.
* Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation.
* Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides and external providers).
* Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis.
* Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems.
* Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflect current plan of care. Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility.
* Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation.
* Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records, and confers with other health care disciplines in providing optimum patient care.
Use your skills to make an impact
Required Experience/Skills:
* Diploma, Associate or Bachelor Degree in Nursing
* Minimum of one year nursing experience preferred
* Strong med surg, ICU, ER, acute experience
* Home Health experience a plus
* Current and unrestricted RegisteredNurse licensure
* Current CPR certification
* Strong organizational and communication skills
* Valid driver's license, auto insurance and reliable transportation.
Pay Range
* $45.00 - $63.00 - pay per visit/unit
* $70,500 - $96,900 per year base pay
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.
$77,200 - $106,200 per year
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 CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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.
$77.2k-106.2k yearly 57d ago
Home Health Licensed Practical Nurse
Humana 4.8
Miamisburg, OH jobs
Become a part of our caring community and help us put health first The Home Health Nursing, LPN/LVN enables patients to stay in their homes by providing health and personal services; supporting patients and their families. The Home Health Nursing, LPN/LVN work assignments are often straightforward and of moderate complexity.
The Home Health Nursing, LPN/LVN assesses and records patient condition by monitoring vital signs. Administers treatments by dispensing medications; changing bandages; administering oxygen supply and equipment. Helps patients care for themselves and helps family members care for the patient by introducing and teaching assisted living techniques such as using a cane or walker, using special utensils to eat, using special techniques and equipment for personal hygiene needs, and appropriate ways to lift, turn, and re-position the patient. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
Use your skills to make an impact
Required Qualifications
Licensed Practical Nurse license in the State of Florida
CPR certification
OSHA Certificate
HIV/AIDS Certificate
HIPAA Certificate
Alzheimer's Certificate
Medical Errors Certificate
Domestic Violence Certificate
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.
Must have a valid in-state driver's license, provide current registration and insurance, and have a driving record with no more than 2 points within the last 3 years.
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 100,000/300,000/100,000 limits.
Scheduled Weekly Hours
1
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.
$53,000 - $73,000 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident.
About Us
About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. OneHome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.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.
$53k-73k yearly Auto-Apply 49d ago
Registered Nurse Home Health
Humana Inc. 4.8
Galion, OH jobs
Become a part of our caring community and help us put health first Make a meaningful impact every day as a CenterWell Home Health nurse. You'll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you'll develop and manage care plans that support recovery and help patients get back to the life they love.
Service area: Crawford and Richland Counties
As a Home Health RN Case Manager, you will:
* Provide admission, case management, and follow-up skilled nursing visits for home health patients.
* Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager.
* Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management, and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation.
* Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides, and external providers).
* Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis.
* Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems.
* Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflects current plan of care. Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility.
* Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation.
* Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records and confers with other health care disciplines in providing optimum patient care
Use your skills to make an impact
Required Experience/Skills:
* Diploma, Associate, or Bachelor Degree in Nursing
* A minimum of one year of nursing experience preferred
* Strong med surg, ICU, ER, acute experience
* Home Health experience is a plus
* Current and unrestricted RegisteredNurse licensure
* Current CPR certification
* Strong organizational and communication skills
* A valid driver's license, auto insurance, and reliable transportation are required.
Pay Range
* $45.00 - $63.00 - pay per visit/unit
* $70,500 - $96,900 per year base pay
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.
$77,200 - $106,200 per year
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 CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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.