Field Care Manager - RN

apartment Humana location_onSchaumburg, IL, US

$78,200 - $107,600 / YEAR

Become a part of our caring community and help us put health first

The Field Care Manager Registered Nurse (RN) assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members and families toward resources appropriate for the care and wellbeing of members. The Field Care Manager Nurse employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues.

The Field Care Manager Registered Nurse key roles and responsibilities may include the following:

Identifies and resolves barriers that hinder effective care.
Ensures member is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations.
Create plans of care.
Communicates with internal and external stakeholders.
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Makes decisions regarding own work methods (occasionally in ambiguous situations), requires minimal direction, and receives guidance where needed.
Follows established guidelines/procedures.
Visits Medicaid members in their homes, Supportive Living Facilities, and/or Long-Term Care Facilities and other care settings – 75-90% local travel (see Additional Information section).

Use your skills to make an impact

Required Qualifications

Applicants must reside in Bond, Clinton, Greene, Jersey, Macoupin, Madison, Monroe, Montgomery, Perry, Randolph, Saint Clair, or Washington County, IL, within one of the following ZIP codes, or within a 10-mile radius of these Zip Codes: 62001, 62002, 62009, 62010, 62012, 62014, 62015, 62016, 62017, 62018, 62019, 62021, 62022, 62023, 62024, 62025, 62026, 62027, 62028, 62030, 62031, 62032, 62033, 62034, 62035, 62037, 62040, 62044, 62046, 62048, 62049, 62050, 62051, 62052, 62054, 62056, 62058, 62059, 62060, 62061, 62062, 62063, 62067, 62069, 62071, 62074, 62075, 62076, 62077, 62078, 62079, 62081, 62082, 62084, 62085, 62086, 62087, 62088, 62089, 62090, 62091, 62092, 62093, 62094, 62095, 62097, 62098, 62201, 62202, 62203, 62204, 62205, 62206, 62207, 62208, 62214, 62215, 62216, 62217, 62218, 62219, 62220, 62221, 62222, 62223, 62224, 62225, 62226, 62230, 62231, 62232, 62233, 62234, 62236, 62237, 62238, 62239, 62240, 62241, 62242, 62243, 62244, 62245, 62246, 62248, 62249, 62250, 62252, 62253, 62254, 62255, 62256, 62257, 62258, 62259, 62260, 62261, 62262, 62263, 62264, 62265, 62266, 62268, 62269, 62271, 62272, 62273, 62274, 62275, 62277, 62278, 62279, 62280, 62281, 62282, 62284, 62285, 62286, 62288, 62289, 62292, 62293, 62294, 62295, 62297, 62298, 62533, 62538, 62560, 62572, 62626, 62630, 62640, 62649, 62667, 62672, 62674, 62683, 62685, 62690, 62803, 62808, 62831, 62832, 62848, 62876, 62877, 62888, 62997
Registered Nurse (RN) in the state of Illinois without disciplinary action.
Clinical nursing experience required (hospital, acute care, or home health
Ability to travel 75-90% within the state of Illinois
Knowledge of community health and social service agencies and additional community resources.
Exceptional communication and interpersonal skills with the ability to quickly build rapport.
Ability to work with minimal supervision within the role and scope.
Ability to use a variety of electronic information applications/software programs including electronic medical records.
Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel.
Humana's Tuberculosis (TB) screening Program 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.
Humana's Driver Safety Program This role is a part of Humana's Driver Safety program and therefore requires and individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits.

Preferred Qualifications

Bachelor of Science in Nursing (BSN).
2+ years of experience of in-home case/care management
Experience with Medicare/Medicaid members.
Experience with health promotion, coaching, and wellness.
Previous managed care experience.
Bilingual — English, Spanish.
Certification in Case Management.
Motivational Interviewing Certification and/or knowledge in area.

Additional Information

Workstyle/Travel: This is a Hybrid – Home position that requires occasional onsite work at the market office in Schaumburg, Illinois, as well 75-90% travel in the field to visit members
Work Schedule: Monday - Friday; 8am - 5pm CST

Work at Home Requirements

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process, we will be using interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

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.

$78,200 - $107,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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.

Share this job

Related Jobs

Utilization Review

Full-time

Care Review Clinician (RN) (Must Reside in IL)

apartment Molina Healthcare location_onChicago, IL

$27.73 - $54.06 / HOUR

JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $27.73 - $54.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Utilization Review

Full-time

Care Review Clinician (RN) (Must Reside in IL)

apartment Molina Healthcare location_onChicago, IL

$27.73 - $54.06 / HOUR

Manager/Supervisor

Full-time

Weekend RN Supervisor

apartment Aperion Care Burbank location_onBurbank, IL

SUMMARY: The RN Nursing Supervisor performs professional supervisory nursing practice in the care of the physically and mentally ill. Work involves responsibility for supervising the provision of quality nursing care given at the facility. The position is responsible for maintaining the quality and adequacy of nursing practice; for coordinating nursing programs; for recognizing and assisting in solving professional, administrative and supervisory problems. Position exercises considerable judgment in applying professional knowledge in solving nursing problems within established policies and practices. ESSENTIAL DUTIES AND RESPONSIBILITIES: Determines the optimal allocation of present staff, per shift and assignment on each unit is present. Coordinates the care of patients on assigned shift. Communicates shifts concerns by unit to appropriate staff (via e-mails, voice mail, etc.). Review of 24 Hour Report and review patients as indicated for change of condition. Serves as administrative authority for the smooth function of all units. Notifies Director or Nursing, Assistant Director of Nursing, Scheduler/Central Supply of urgent concerns during the shift. When the concern is non-urgent, notifies manager by phone message or e-mail. Receives employee, resident and family grievances. Refers information to appropriate manager. Assists nurses in completing risk assessments and investigations of injury. Notifies Assistant Director of Nursing and Human Resources Director of identified learning needs. Receives employee call-offs. Records call-offs and updates schedule. Notifies managers/supervisors of call-offs in their units via voice mail. Replaces for absences and vacancies for upcoming shift(s). Assists staff to pick up hours (call-in phone, e-mail, vacancy lists, 72-hour availability list). Works with the Staffing Coordinator and Director of Nursing to assure that vacancies are filled in advance. Performs rounds to monitor the conditions and care of acutely ill patients. Supervises staff and assures survey compliance on a daily basis. Provides guidance and support to staff to better plan work flow. Receives reports throughout the shift. Completes reports for “I” team members on each unit. Assists nurses in assessing residents who are experiencing acute changes. Provides clinical expertise in the management of medical and psychiatric emergencies. Responds to code blue, medical assist situations. Assists staff, as needed. Provides clinical expertise in medical management, crisis and behavior management techniques. Audits charts routinely. Provides clinical expertise in documentation, including MDS, Medicare PPS, acute illness charting, weekly summaries and care planning. Ensures timely notification of MD/Family Representatives where warranted. Obtains supplies from medical supply after hours. Restocks the crash cart immediately after use. Directs staff response to emergencies, such severe weather, fire or bomb scare. Participates in fire drills. Directs disaster evacuation plan, as needed. Meets routinely with the Director of Nursing and Assistant Director of Nursing. Assists with the development and implementation of nursing policies and procedures. Attends facility Quality Assurance and Performance Improvement Meetings. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required. Registered Nurse with current unencumbered state licensure. Supervisory experience in a team leader role. Work experience as a professional nurse. CPR certification. PHYSICAL DEMANDS: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Required to sit, stand, bend and walk regularly; lift and/or move up to 100 pounds. Visual and auditory ability sufficient for written and verbal communication. The noise level in the work environment is usually moderate.

Director of Nursing

Full-time

Director of Nursing (DON)

apartment Aperion Care Burbank location_onBurbank, IL

** $10,000.00 SIGN ON BONUS ** SIGN ON BONUS SUBJECT TO TERMS AND CONDITIONS AND MINIMUM HOURS MET SUMMARY: The primary purpose of the Director of Nursing position is to plan, organize, develop and direct the overall operation of our Nursing Department in accordance with current federal, state, and local standards, guidelines, and regulations that govern our facility, and as may be directed by the Administrator and the Medical Director, to ensure that the highest degree of quality care is maintained at all times. ESSENTIAL DUTIES AND RESPONSIBILITIES: Plan, develop, organize, implement, evaluate, and direct the nursing service department, as well as its programs and activities, in accordance with current rules, regulations and guidelines that govern the nursing care facilities. Develop, maintain, and periodically update written policies and procedures that govern the day-to-day functions of the nursing service department. Make written and oral reports/recommendations to the Administrator, as necessary/required, concerning the operation of the nursing service department. Develops methods for coordination of nursing services with other resident services to ensure the continuity of the residents’ total regimen of care. Maintain an ongoing quality assurance program for the nursing department. Participate in facility surveys made by authorized government agencies as necessary or as may be directed. Assist the Quality Assessment & Assurance Committee in developing and implementing appropriate plans of action to correct identified deficiencies. Assist with discharge planning and perform administrative duties such as completing medical forms, reports, evaluations, studies charting, etc. Monitor the facility’s QI, QM, and survey reports. Assist in the developing plans of action to correct potential or identified problem areas. Assist in calculating the number of direct nursing care personnel on duty each shift. Assign a sufficient number of licensed practical and/or registered nurses for each tour of duty to ensure that quality care is maintained. Assign a sufficient number of certified nursing assistants for each tour of duty to ensure that routing nursing care is provided to meet the daily nursing care needs of each resident. Develop work assignments and schedule duty hours, and/or assist nursing supervisory staff in completing and performing such tasks. Delegate to nursing personnel the administrative authority, responsibility and accountability necessary to perform their assigned duties. Make daily rounds of the nursing service department to ensure that all nursing service personnel are performing their work assignments. Assist the HR Director in developing performance evaluations on an annual basis for the nursing department. Ensure that departmental disciplinary action is administered fairly and proper documentation for such discipline is given to HR Director for personnel file. Assist with infection control monitoring in establishing a TB management program for employees. Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals. Ensure that the department’s policy and procedure manuals identify safety precautions and equipment to use when performing tasks that could result in bodily injury. Assist in identifying, evaluating, and classifying routing and job-related functions to ensure that tasks in which potential exposure to blood/body fluids are properly identified and recorded. Ensure that all personnel performing tasks that involve exposure risks participate in proper in-service training programs. Review nurses’ notes to ensure that they are informative and descriptive of the nursing care being provided, that they reflect the resident’s response to the care, and that such care is provided in accordance with the resident’s wishes. Monitor medication passes and treatment schedules to ensure that medications are being administered as ordered and that treatments are provided as scheduled. Provide direct nursing care as necessary. Coordinate continuing education/in-service training for nursing department. Report suspected or known incidence of fraud to Administrator. Assist the MDS/Care Plan Coordinator in planning, scheduling & revising the MDS, including the implementation of RAPs and Triggers. Encourage the resident and his/her family to participate in the development and review of resident’s plan of care. Maintain confidentiality of all resident care information including protected health information. Report known or suspected incidents of unauthorized disclosure of such information. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required. Must have, as a minimum, 3 years of experience as a supervisor in a hospital, nursing care facility, or other related health care facility. Registered Nurse with current unencumbered state license. Current CPR Certification is required. Must be able to read, write, speak and understand English language. Must be a supportive team member, contribute to and be an example of team work and team concept. Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public. Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to nursing care facilities. Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures that are necessary for providing quality care. Must be able to relate information concerning a resident’s condition. Must possess the ability to make independent decisions when circumstances warrant such action. PHYSICAL DEMANDS: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to move intermittently throughout the workday. Must be able to cope with the mental and emotional stress of the position. Must meet the general health requirements set forth by the policies of the facility, which include a medical and physical examination. Must be able to push, pull, move, and/or lift a minimum of 25 lbs. to a minimum height of 5 feet and be able to push, pull, move and/or carry such weight a minimum distance of 50 feet. May be necessary to assist in the evacuation of residents during emergency situations. APERCHI3

Full-time

RN Leadership Opportunity-RN Clinical Coordinator NMH

apartment Northwestern Medicine location_onChicago, IL

Description The RN Clinical Coordinator reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. This role requires an experienced Registered Nurse who works collaboratively with, and under the direction of, the unit manager to lead shift operations. Responsibilities include overseeing patient care, managing patient and unit flow, assigning staffing and resources, and supporting clinical staff. The role encompasses both administrative duties and direct patient care responsibilities. We have both day and night shifts available depending upon unit of interest. Responsibilities: Facilitates unit operations on a shift basis according to policy, procedure, and regulatory requirements. Coordinates unit based staffing assignments on a shift basis to achieve high quality and cost effective care. Directs patient care provided by staff nurses and support personnel for a specific shift. Champions new initiatives and helps in unit/departmental or hospital wide committees/task forces. Communicates directly with patients and significant others about nursing care. Implements appropriate action plans to provide safe, quality, and efficient care. Assures safety and security of patients, significant others, and staff. Provides direct patient care. Performs ongoing assessment of assigned patients and their significant others’ biopsychosocial and learning needs. Implements appropriate actions to respond to needs of patients and their significant others. Monitors and documents the patient’s response to therapeutic interventions and progress toward outcomes. Assures that quality improvement activities are completed for the assigned shift. Assesses and intervenes in critical situations involving patients, staff, and visitors and consults with manager or administrator for guidance as needed. Ensures that the environment is clean, attractive, safe and free from hazards for patients, staff and visitors in accordance with regulatory requirements. Analyzes patterns of daily activities and recommends operational/program changes as needed. Anticipates staffing needs for subsequent shifts and makes necessary arrangements for coverage. Facilitates effective interdepartmental communication of incidents with appropriate personnel (manager, administrator, medical staff, etc.). Identifies and communicates key issues and trends to managers and makes recommendations for improvement on an ongoing basis. Provides input to manager on budgetary issues, particularly staffing and cost containment strategies. Establishes relationships across departments to optimize patient care. Assesses and communicates staff development needs to manager. Orients staff to Clinical Coordinator and Charge role. Serves as a resource for staff. Qualifications Required: Baccalaureate degree from an accredited school of nursing or equivalent experience as approved by the Patient Care Director. (Minimum two years clinical experience in area of clinical specialty). Registered Nurse in the state of Illinois Two or more years in clinical specialty (NMH only) Holds Magnet recognized certification or obtains within 1 year (specialty certification in clinical area is preferred) CPR – Basic Life Support Preferred: (NMHC, excluding NMH) Holds specialty clinical area certification Equal Opportunity Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status. If we offer you a job, we will perform a background check that includes a review of any criminal convictions. A conviction does not disqualify you from employment at Northwestern Medicine. We consider this on a case-by-case basis and follow all state and federal guidelines. Benefits We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.