Humana

Compensation

Full Description

Job Description: • perform primarily face to face and telephonic assessments to adult and pediatric members • evaluate member's needs to achieve and/or maintain optimal wellness • employ a variety of strategies, approaches, and techniques to manage a member's health issues and identify and resolve barriers that hinder effective care • ensure members are progressing towards desired outcomes by continuously monitoring care through use of assessment, data, conversations with member, and active care planning • manage a case load and complete assessments with members in their home or community-based setting, as well as telephonically • provide clinical support and guidance, particularly for members with medical complexity • develop and coordinate care plans ensuring that patients receive appropriate services to manage their health needs effectively • address barriers to health care and advocate for optimal member outcomes • review, assess, and complete medical complexity attestations and clinical oversights • ensure members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs • develop and modify Individual Care Plan and involve applicable members of the care team in care planning (Informal caregiver, coach, PCP, etc.) • focus 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 • collaborate with Community Health Workers (CHW), Housing Specialist and other internal and external agencies for HRSN needs • be the primary point of contact for the ICT and responsible for coordinating with the member, ICT participants, and outside resources to ensure the member’s needs are met Requirements: • Must reside in the Commonwealth of Northern Virginia • Active Registered Nurse (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 Benefits: • 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 • many other opportunities