RN, Field Care Manager, Maternity, L&D, Mother Baby at Humana

About the position

Humana Healthy Horizons in Ohio is seeking a dedicated RN Field Care Manager 2 with expertise in Maternity, Labor & Delivery, and Mother Baby care. This role is crucial in assessing and evaluating the needs of members to help them achieve and maintain optimal wellness. The Field Care Manager will serve as a vital link, connecting members and their families with the appropriate resources necessary for their care and overall wellbeing. The RN Field Care Manager will operate in either a Care Management (CM) or Care Management Plus (CM Plus) capacity, depending on the specific needs of the members they serve. This position requires a high level of independence and the ability to interpret complex situations to determine the best course of action for each member. In the CM role, the RN will perform a full range of care coordination activities for members who are not assigned to a Care Coordination Entity, such as the Ohio RISE Plan or a Care Management Entity (CME). They will act as the single point of contact for these members, ensuring that they receive the necessary support and resources. In the CM Plus role, the RN will ensure that members assigned to a Care Coordination Entity receive comprehensive care coordination services, including the completion of assessments and care plans, while also minimizing duplication of services with other entities. The RN Field Care Manager will employ various strategies to manage members' physical, environmental, and psycho-social health issues. They will identify and resolve barriers to effective care, utilizing a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs. This includes performing both telephonic and face-to-face assessments to guide members toward the appropriate resources for their care. Continuous monitoring of member progress towards desired outcomes is essential, as is collaboration with providers and community services to promote quality and cost-effective outcomes. The RN will coordinate the delivery of necessary services and supports, ensuring a seamless transition of care across the transdisciplinary care team.

Responsibilities
?? Perform the full scope of care coordination activities for members not assigned to a Care Coordination Entity.
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?? Serve as the single point of contact for care coordination.
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?? Ensure completion of comprehensive assessments and person-centered care plans for assigned members.
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?? Provide actionable data and support to assist Care Coordination Entities in meeting member care needs.
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?? Employ strategies to manage members' physical, environmental, and psycho-social health issues.
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?? Identify and resolve barriers to effective care.
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?? Utilize a holistic approach to engage and motivate members and their families.
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?? Perform telephonic and face-to-face assessments of member needs.
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?? Continuously monitor member progress towards desired outcomes.
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?? Collaborate with providers and community services to promote quality outcomes.
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?? Coordinate delivery of needed services and supports for Physical Health and Social Determinants of Health.

Requirements
?? Must reside in the state of Ohio.
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?? Registered Nurse (RN) in the state of Ohio without restrictions.
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?? Minimum two (2) years of clinical experience, including Maternity, Labor & Delivery, and Mother Baby.
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?? Intermediate to advanced computer skills and experience with Microsoft Word, Outlook, and Excel.
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?? Exceptional communication and interpersonal skills with the ability to quickly build rapport.
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?? Ability to work with minimal supervision within the role and scope.
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?? Complete education and self-development activities as required.
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?? Valid state driver's license and proof of personal vehicle liability insurance with specified limits.
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?? Ability to provide a high-speed DSL or cable modem for a home office.

Nice-to-haves
?? Case Management Certification (CCM).
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?? Experience working with Medicare, Medicaid, or dual-eligible populations.
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?? Field Case Management Experience.
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?? Health Plan experience.
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?? Knowledge of community health and social service agencies.
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?? Experience with health promotion, coaching, and wellness.
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?? Bilingual (Spanish, Somali, or other).

Benefits
?? Work from home flexibility with required internet speed standards.
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?? Telephone equipment provided for business requirements.

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