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New Beginnings Case Manager - (Role Number: 187103)

02/02/2018Call Center
Job Location:
Charlotte, NC
Metro Area:
NC - Charlotte
Company Name: Humana Inc.
Website:  Click to Visit
Role: New Beginnings Case Manager (RN)

Assignment: Humana Government Business - Clinical Guidance

Location: Work at Home- Nationwide (Central and Eastern time zones preferred)

 

OVERVIEW

 

Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their families. For more than 20 years, Humana Military has strived to create better health outcomes and simplified experiences for millions of beneficiaries across the United States through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, and progressive approaches to care drive Humana Military to be a thought leader in the industry and an essential partner to the Government.

 

 

ROLE SUMMARY

 

The New Beginnings Clinical Advisor will have personal interaction with TRICARE beneficiaries identified for New Beginnings program through analytics or referral.  The New Beginnings advisor will provide prenatal education and resources on pregnancy, pregnancy-associated conditions, and chronic health conditions affecting pregnancy.  The NB Advisor will provide ongoing support for beneficiaries from the earliest stages of pregnancy up to six weeks following birth or longer for infants in NICU.   The NB Advisor will serve as a point of contact for pregnant beneficiaries assisting in planning, coordinating, implementing, monitoring, and evaluating medical services needed to meet the healthcare needs of the TRICARE beneficiaries enrolled in the program.  The New Beginnings Clinical Advisor will coordinate with hospitals, attending physicians, the beneficiarys PCM, and other members of the healthcare team to provide ongoing clinical review to include authorizations, concurrent review, and discharge planning services should a mother or infant required extended care.  The NB Clinical Advisor will also coordinate care with case managers within HGBs Integrated Care Team, MTF case managers, and facility case managers. UM support for inpatient NICU and new mothers. Perform all duties within the scope of his/her practice.

 

Our Department of Defense Contract requires U.S. citizenship for this position.

 

  • Utilize applicable sources of information to identify, assess, and enroll patients eligible for the New Beginnings Program.  Contact enrolled beneficiaries via outbound calls or preferred method of contact, to assess and provide guidance/education/resources per protocols.  Provides a point of contact for beneficiaries with pregnancy / post-partum related needs. Update the Care Management System per HGB Medical Affairs policies and procedures; complete all reporting requirements in a timely manner
  • Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the New Beginnings program, including conducting authorizations, concurrent review, and discharge planning activities for NICU admissions.  Will follow admissions through discharge, coordinating care and / or referring cases to Case Management members of the ICT as needed based upon the beneficiaries needs and clinical condition.  Maintain beneficiarys privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.
  • Coordinate and collaborate with other external programs and / or members of the ICT to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting all interventions and outcomes for beneficiaries within the case management and ICT team.

Role Essentials:

  • Registered Nurse with current in state RN license
  • Case Management Certification (CCM)
  • Three years (3) experience in maternal / child nursing with NICU experience  
  • Interqual (or Milliman) knowledge
  • Computer literate
  • Good communication skills, verbal and written
  • Good organizational skills
  • U.S. Citizenship is required by our Department of Defense contract

 

Role Desirables:

  • Bachelors degree in nursing / healthcare
  • Two (2) years case management experience
  • Utilization Management

Additional Information

 

Humana is an organization with careers that change livesincluding yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If youre ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

 

Apply now, or join our Talent Network so you can stay informed and up to date on whats happening at Humana.

 
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