Humana Inc. is seeking a NICU Care Manager, Telephonic Nurse 2 to join our caring community. In this role, you will assess and evaluate members' needs in a telephonic environment to achieve optimal wellness, guiding members and families toward appropriate healthcare resources. You'll collaborate with providers to review medical care against CMS guidelines, following members from NICU admission through discharge.
What You'll Do
- Assess and evaluate members' needs and requirements to achieve and maintain optimal wellness.
- Guide members and families toward and facilitate interaction with appropriate healthcare resources.
- Collaborate with other health care providers in reviewing actual and proposed medical care and services against CMS Coverage Guidelines.
- Follow members from the beginning of their NICU stays until discharge.
- Perform clinical case review on members during an inpatient hospital admission.
- Assess care needs and assist in coordinating interventions and services to meet those needs.
- Communicate with providers and Humana associates to promote efficient use of the healthcare system.
- Provide authorizations for inpatient stay.
- Provide care coordination and discharge planning.
- Provide home health and medical equipment coordination.
- Partner with facilities to support superior care.
What We're Looking For
- Registered Nurse (RN) with 3 years or more of NICU level 3 experience.
- Active Compact RN license with the ability to apply for additional licensure without restrictions if needed.
- Ability to work independently under general instructions and with a team.
- Team player.
- Strong organizational skills and experience multi-tasking.
Nice to Have
- BSN or Bachelor’s degree in a related field.
- Health Plan experience.
- Previous experience in utilization management, discharge planning and/or home health or rehab.
- Bilingual – preferably Spanish.
- Clinical claim review experience.
Benefits & Compensation
- Medical, dental and vision benefits.
- 401(k) retirement savings plan.
- Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave.
- Short-term and long-term disability.
- Life insurance.
- Compensation: $71,100 - $97,800 per year.
Work Mode
This position is remote.
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.
