Remote Rn Utilization Review Nurse Jobs in Ocala, FL

Become a part of our caring community
The Care Coach evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Coach 1 work assignments are often straightforward and of moderate complexity. Reports to the Regional Care Coach ManagerWe are looking for motivated and dynamic case managers that reside in the following areas: Alachua, Marion, Levy counties in FLORIDA

Current starting salary is $60-64K/year based on qualifications/experience

This rewarding role allows you to spend time connecting with our members to ensure they receive the services they need. The Care Coach 1 role involves meeting members in their location, spending quality time assessing their needs and barriers and then connecting our members with quality services to promote their ultimate well-being and drive health outcomes. If you enjoy applying your creativity and skills to help those in need find long term solutions, this role is for is for you! Here at Humana we thrive on teamwork and highlighting the success of each of our team members.

At Humana one of our main areas of focus is to inspire health in others. We are looking for individuals who enjoy talking to others about their health while providing education and encouragement. We also desire to cultivate the uniqueness in each of our associates as well as our members and are looking for individuals from various backgrounds who can bring their expertise to the role of the Care Coach 1. If you are looking for a new work family and team of dynamic professionals, we hope you will apply!

The Care Coach 1

• Visit Medicaid members in their homes, Assisted Living Facilities, and/or Long Term Care Facilities and other care settings - 75-90% local travel
• Assesses and evaluates member's needs and requirements in order to establish a member specific care plan
• Ensures members are receiving services in the least restrictive setting in order to achieve and/or maintain optimal well-being
• Planning and implementing interventions to meet those needs
• Coordinating services, and monitoring and evaluating the case management plan against the member's personal goals
• Guides members/families towards resources appropriate for their care
• Services are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams and others involved in the member's care as appropriate and required by our comprehensive contract

Use your skills to make an impact

Required Qualifications

• Care Coaches shall meet one of the following qualifications:
  • Bachelor's Degree with at least 2 years of relevant experience (Health Services, Social Work, Psychology)
  • Registered Nurse (RN), licensed in the state of Florida with at least 2 years of relevant experience.
  • Licensed Practical Nurse (LPN), licensed in the state of Florida, with at least 4 years of relevant experience
  • Case Worker with a minimum of 6 years of Health Services/Case Management Experience

• Prior experience with Medicare & Medicaid recipients
• AHCA Fingerprint Required.
• This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
• This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance
• Schedule is Monday-Friday 8:30am-5:00pm

Preferred Qualifications

• Bilingual English/Spanish with ability to pass a Language Proficiency Exam
• Community Health Worker
• Prior nursing home diversion or long term care case management experience
• Experience with electronic case note documentation and documenting in multiple computer applications/systems
• Experience working with geriatric population
• Experience with health promotion, coaching and wellness
• Knowledge of community health and social service agencies and additional community resources
• 701B Certification
• Medication application (RFA) experience

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Florida Background Screening Requirements: Notice for candidates applying to this position from a Florida work location, including Florida home-based work location. This position is subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse. For information about the screening process and requirements, visit: https://info.flclearinghouse.com.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$53,700 - $72,600 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.