Resource Utilization Group Auditor III – Skilled Nursing Facility, SNF
EXL
Bilingual RN Care Manager
Humana
full-time
Posted on:
Location Type: Hybrid
Location: California, Illinois, Montana, South Dakota • 🇺🇸 United States
Visit company websiteSalary
💰 $71,100 - $97,800 per year
Job Level
Mid-LevelSenior
About the role
- Telephonically assess Medicare, Medicaid, and/or Group Account members and create actionable and measurable care plans
- Provide telephonic outreach to assess and support members' health, offering education, identifying resources, and helping remove barriers
- Use nursing judgment to assess and coordinate care for acute situations (APS, EMS)
- Discuss transitions of care to assist with safe discharge to the home and coordinate care for DME, home health, provider appointments, etc.
- Guide members and their families toward and facilitate interaction with resources appropriate for the care and wellbeing of members
- Assess member’s physical, environmental and psycho-social health issues and work in collaboration with a multi-disciplinary team (social workers, dietitians, pharmacists, etc.)
- Employ a variety of strategies/techniques to manage conditions and provide timely intervention
- Meet quality and productivity measures daily while working from home
- Perform majority of member contact via telephone using an auto-dialer system and navigate multiple computer applications concurrently
- Complete initial training (first 4 weeks) on specified EST schedule and start regular shift thereafter
- Maintain compliance with program requirements and protect member PHI/HIPAA
- Occasional travel to Humana offices for training or meetings may be required
Requirements
- Active Registered Nurse (R.N.) license with no disciplinary action
- Hold an active Compact nursing license and reside in the state that holds your compact license
- License must be current with no disciplinary action
- Must be bilingual in Spanish and Engligh - resume must be submitted in English
- Oral and written fluency in Spanish and English - ability to pass a language test will be required
- Minimum of an Associate's degree in Nursing
- Seasoned RN with a minimum of 3 years of clinical nursing experience
- Demonstrated clinical knowledge and expertise managing a variety of chronic conditions, including development and implementation of individualized care planning
- Intermediate to advanced computer skills; ability to navigate multiple systems and utilize dual computer monitors
- Experience with Microsoft and Excel
- Ability to quickly learn and navigate software programs and applications
- Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously
- Effective communication and interpersonal skills
- Effective problem solving and appropriate application of clinical knowledge
- Must have a separate room with a locked door as a home-office to ensure absolute and continuous privacy (PHI / HIPAA)
- Must possess advanced telephonic and virtual communication skills
- Maintain working home internet at all times meeting recommended speeds (minimum recommended download 25 Mbps and upload 10 Mbps)
- Satellite, cellular and microwave connections only if approved by leadership
- Preferred qualifications:
- BSN or MSN degree in nursing or equivalent
- Previous adult chronic conditions care management experience
- Previous experience in care management including knowledge of complex care management and care management principles
- Experience with motivational interviewing
- Experience with MCG or CMS guidelines, assessment and documentation practice
- Case Management certification (CCM)
Benefits
- Benefits starting day 1 of employment
- Competitive 401k match
- Generous Paid Time Off accrual
- Tuition Reimbursement
- Parent Leave
- Go365 perks for well-being
- 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
- Bonus incentive plan eligibility
- Bi-weekly internet payment for associates who live and work from Home in California, Illinois, Montana, or South Dakota
- Employer-provided telephone equipment
- Occasional travel reimbursement for training/meetings
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Registered Nurse (R.N.) licensebilingual in Spanish and Englishclinical nursing experienceindividualized care planningmotivational interviewingMCG guidelinesCMS guidelinescase managementcomputer skillstelephonic communication
Soft skills
effective communicationinterpersonal skillsproblem solvingability to manage multiple prioritiesnursing judgmentcollaborationtime managementadaptabilityattention to detailempathy
Certifications
Case Management certification (CCM)Compact nursing license
