RN Field Care Manager – Medicaid HCBS/LTSS

🕒 5 dias atrás

🚗 Michigan – Remoto

🚗 Michigan – Remote

💵 $71.100 - $97.800 / ano

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

👔 Gerente

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Humana

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1961

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

A Humana é uma empresa de saúde dedicada a gerar um impacto positivo na saúde de indivíduos, comunidades e do sistema de saúde como um todo. Com foco em colocar a saúde em primeiro lugar, a Humana atende a uma ampla e diversa gama de populações, incluindo idosos e militares, oferecendo planos Medicare Advantage (HMO, PPO e PFFS). A Humana está comprometida em promover uma cultura de pertencimento e respeito mútuo, oferecendo benefícios competitivos e flexíveis para garantir a segurança financeira de seus funcionários e de suas famílias. A empresa se orgulha de criar um ambiente de trabalho inclusivo, no qual todos têm a oportunidade de ter sucesso.

Descrição

• Assess members’ needs and help members and families access appropriate resources to achieve or maintain optimal health and well-being • Use strategies to address members’ physical, environmental, and psychosocial health needs • Manage a caseload and complete member assessments in home, community-based, and telephonic settings • Provide clinical support and guidance, particularly for members with complex medical needs • Develop and coordinate care plans to ensure appropriate services • Address barriers to healthcare and advocate for optimal member outcomes • Review, evaluate, and complete medical complexity attestations and clinical oversight activities • Assess care needs to ensure services are provided in the least restrictive setting • Develop and update Individual Care Plans with care team members, informal caregivers, coaches, and primary care providers • Help members and caregivers access social, housing, educational, and other services • Serve as primary contact for the Interdisciplinary Care Team (ICT) • Coordinate with members, ICT participants, and external resources • Conduct comprehensive InterRAI Integrated Health Care (IHC) assessments • Conduct Nursing Facility Level of Care Determinations (NFLOCDs) • Support accurate eligibility decisions and person-centered care planning • Ensure compliance with state Medicaid, LTSS, HCBS waiver, and regulatory requirements • Travel 75%–90% within Wayne and/or Macomb Counties for in-home visits

🎯 Requisitos

• Must reside in Michigan, specifically Wayne or Macomb Counties • Active Michigan license as a Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN), including Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS), with no disciplinary actions • Experience with Home and Community-Based Services (HCBS) and waiver programs • 2+ years of experience in healthcare and/or case management • Experience conducting Long-Term Services and Supports (LTSS) assessments • Experience working with Medicaid regulations • Experience applying person-centered planning principles • Experience collaborating with interdisciplinary teams, providers, members, and caregivers to complete comprehensive assessments and recommend appropriate services • Ability to maintain timely, accurate, and compliant documentation in accordance with organizational, state, and federal requirements • Knowledge of community health, social service agencies, and community resources • Ability to use electronic information systems and software programs, including electronic medical records (EMRs) • Excellent keyboarding and web navigation skills • Intermediate to advanced computer skills, including Microsoft Word, Outlook, and Excel • Valid state driver’s license and personal vehicle liability insurance • Must complete TB screening • Bachelor of Science in Nursing (BSN) preferred • Experience completing InterRAI Integrated Health Care (IHC) assessments preferred • Experience conducting and documenting Nursing Facility Level of Care Determinations (NFLOCDs) preferred • Experience in health promotion, coaching, and wellness preferred • Previous experience in managed care preferred

🏖️ Benefícios

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Mileage reimbursement for eligible travel • Self-provided internet requirements for home or hybrid home/office employees • Occasional travel to Humana offices for training or meetings