Telephonic Nurse Case Manager

at Humana in Augusta, Maine, United States

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The Telephonic Nurse Case Manager will be a member of the Case Management Team, providing a comprehensive, holistic approach for case management throughout the continuum of care. The case manager will offer guidance. support, and coordination of the beneficiarys care as directed by the beneficiary, the provider(s) or other members of the healthcare team and within the scope of the case managers licensure. The case manager will assess, plan, coordinate, implement, monitor, and evaluate the medical services required to meet the complex health needs of TRICARE beneficiaries, to maximize each beneficiarys capacity for self-care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care. The case manager will collect and document data to facilitate measurement of case management involvement. The case manager will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical and behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in addition to MTF UM / CM staff, physicians and providers as necessary; organize, arrange and coordinate services necessary to address the beneficiarys condition. In their role, the Case Manager will collaborate with other care management programs until the beneficiarys needs are met and case closure or graduation is achieved. Performs all duties within the scope of licensure.

Role responsibilities :

35% Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the Case Management purview across the continuum of care. Develop a cost effective treatment plan that is acceptable to both the beneficiary (patient) and other members of the care team utilizing both evidence based medical information, DoD and community resources ( SDOH ). Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care. Maintain beneficiarys privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.

30% Utilize applicable sources of information to identify, assess, and enroll patients requiring case management.

25% Coordinate and collaborate with other members of the care management team or external programs to ensure a fully i