Care Manager, Telephonic Compact Registered Nurse - Remote Eligible

Become a Part of Our Caring Community and Help Us Put Health First

The Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness by providing care coordination to members/families and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Humana Care Support is a division of Humana dedicated to helping adults remain independent in their homes. Our nurses are titled Care Managers, because our case management services are centered on the person rather than the condition. The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patients are 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.

Role Overview

• The nature of the work requires telephonic interaction with members during the majority of the business day, primarily through an auto dialer system.
• This is a fast-paced environment and requires the ability to engage quickly with members while concurrently navigating multiple computer applications. To ensure compliance and support the auto dialer process essential to our business, the daily schedules of care managers must remain structured. As a result, day-to-day flexibility is limited.
• All our RN Care Managers are work at home associates, working from a dedicated home office space (see Work at Home Guidance below).
• Remote Care Managers are expected to achieve established outcomes, quality, and productivity benchmarks and demonstrate advanced communication and interpersonal skills.

Duties Include

• Telephonically work with Medicare members with transitional needs and complex chronic conditions.
• Assess member's physical, environmental, and psycho-social health issues, and work in collaboration with a multi-disciplinary team, employing a variety of strategies/techniques to manage appropriately and provide timely clinical intervention.
• Evaluate members' risks, coordinate care, and provide clinical interventions to prevent avoidable hospitalizations.
• Collaborate with members who face multiple chronic conditions, along with financial and functional challenges, to support them in achieving and sustaining optimal health.

Use Your Skills to Make an Impact

Required Qualifications

• Unrestricted Registered Nurse (RN) license in state of residency, with active multistate (compact) status, without disciplinary action.
• 3+ years of clinical acute care experience with case management, discharge planning, and patient education for adult acute care
• Demonstrated clinical knowledge and expertise as evidenced by providing clinical interventions to manage a variety of chronic conditions, including development and implementation of individualized care planning.
• Demonstrated clinical assessment and critical thinking skills.
• Intermediate to advanced knowledge of Microsoft Office applications including Word, Excel, and Outlook.
• Intermediate to advanced computer skills as evidenced by ability to navigate multiple systems, utilizing dual computer monitors. With the ability to quickly learn and navigate software programs and applications.
• Demonstrated ability to provide autonomous decision-making, troubleshooting and problem solving related to periodic system issues.
• Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously.
• Demonstrated flexibility and ability to promptly adapt to new processes and workflows.
• Advanced telephonic and virtual communication skills, both verbal and written

Preferred Qualifications

• BSN or MSN degree
• Knowledge of Milliman or Interqual
• Managed care experience
• Certified Case Manager (CCM)
• Bilingual in English and Spanish (see Language Proficiency Testing below)

Training and Work Schedule

• The initial four weeks will be dedicated to training, and the training schedule may differ from the regular work schedule.
• A set work schedule will be determined after training is completed. The standard start time will be determined according to business requirements and may fall anywhere between the hours of 8:00 AM and 10:00 AM in the selected candidate's local time zone.

Work at Home Guidance

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required.
• 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.

Language Proficiency Testing

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.

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.

Social Security Task

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours 40

Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 10-22-2025

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