RN Care Manager, Telephonic

$71,100 - $97,800 / year

Become a part of our caring community

The Care Management Telephonic Nurse is a licensed registered nurse who works within an interdisciplinary team to support Independent Care members with complex, episodic medical, behavioral health, and social needs. You will report to the Manager of Care Management Support. You will work alongside health care providers, behavioral health professionals, and social service agencies to promote high quality, efficient, and cost effective delivery of health and social services through assessment, care planning, coordination, and ongoing monitoring.

Assist Care Coordinators and Care Managers in the oversight, development, and prioritization of member care plans addressing complex medical, behavioral health, and social needs.
Monitor member status and direct members to appropriate specialty services, community resources, and alternative treatment settings.
Participate in coordinating member discharge needs in collaboration with facility discharge planners, Care Coordinators, Care Managers, and behavioral health personnel, and assists with medical transitions of care.
Coordinate services, communicate clinical information, and interface with health care providers regarding the management of current medical, behavioral health, and social needs.
Support the high risk and complex case management team with completing comprehensive assessments and managing members
Educate on chronic conditions and preventive health measures -
Interpret and administer benefits following regulatory requirements, contractual obligations, and medical management guidelines.
Problem‑solve with staff, members, and providers to identify appropriate alternatives or solutions to care needs.
Complete accurate, timely, and compliant documentation following iCare policies, workflows, and documentation standards.
Participate in interdisciplinary team meetings as a member or facilitator.
Be a clinical resource to iCare staff and assist with training and mentoring of employees.
Occasionally assist in developing and delivering presentations to external agencies or organizations.
Support program development, policy and procedure enhancements, and provide input to Quality Improvement and Quality Assurance initiatives.
Perform other duties as assigned, including mentoring and special projects.

Use your skills to make an impact

Required Qualifications

Bachelor's degree
Minimum 2 years of clinical acute care experience
Licensed Registered Nurse (RN) in WI with no disciplinary action.

Preferred Qualifications

Experience with case management, discharge planning and patient education for adult acute care
Managed care experience
Reside within the State of WI

Additional Information

Workstyle: Hybrid Home
Work Location: Remote within Wisconsin
Typical Work Days/Hours: Monday through Friday, 8:30 am – 5:00 pm CST.

WAH Internet Statement

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.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees 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 employees 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.

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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.

$71,100 - $97,800 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

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 at Humana.com and at CenterWell.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.

Share this job

Related Jobs

Clinic Nurse RN

Children's Wisconsin Delafield, WI

At Children’s Wisconsin, we believe kids deserve the best. Our pediatricians and primary care offices offer parents a level of care that cannot be obtained at other places: Affiliation with the #4 children's hospital in the country (according to Parents magazine) Board-certified pediatricians (l earn what it means to be 'board-certified' ) Many locations spread throughout southeast Wisconsin Commitment to population health and an increased role for pediatricians in the care of children Doctors who are very active in their local communities Access to many health and wellness programs designed to keep kids safe and healthy We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today. Please follow this link for a closer look at what it’s like to work at Children’s Wisconsin: https://www.instagram.com/lifeatcw/ Job Summary The RN role practices within the Code of Ethics and Standards of Nursing Practice. Performs triage via phone and patient messaging in the electronic health record. Delegates patient care responsibilities appropriately, and maintains accountability for the quality of care. Provides for the health education needs of families with a focus on self-management and preventive health. Essential Functions - Adheres to all Children’s Wisconsin and Children’s Medical Group policies, procedures, and standards. Ensures confidentiality to our customers by creating and maintaining a secure and trusting environment; maintains HIPAA compliance. Provides exceptional care to patients and families to fulfill our patient experience promise. - Regularly performs RN duties and maintains own patient care competencies as determined by position scope of practice. Ability to provide in person clinical care during nurse visits, providing education to families, and coordination of care as needed. - Notifies provider of any patient needing immediate assistance. - Collaborates with other disciplines as required to coordinate patient assessment, develop/monitor outcomes, implement plan of care, and monitor variances to ensure quality patient care. - Provides nursing care via telephone triage and electronic health record, using standardized pediatric assessment, care protocols and patient guidance and education to the necessary dispositon of care. - Documents in accordance with organizational nursing standards. - Adapts to changing work assignments and schedules. - Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards Education: - Graduate of an accredited school of nursing in order to meet the recommended entry level for a professional nurse required - Bachelor's Degree Nursing preferred Experience: - 2+ years experience in a primary care or urgent care setting preferred - Experience with pediatric patients preferred - Triage experience in a clinical pediatric setting preferred Knowledge, Skills and Abilities - Ability to work with a diverse patient population to promote a culturally competent environment. - Strong interpersonal skills for positive and effective interaction with patients, families, visitors, providers, and the health care team. - Good organization, delegation, and communication skills to facilitate efficient patient care. - Strong demonstrated ability in assessment, analytical decision making, and critical thinking. - Analytical skills are necessary to assess complex patient conditions effectively. Requires the ability to synthesize multiple sources of information to assist in patient care. - Ability to assist and support other primary care locations as requested by leaders and/or the Children’s Medical Group float policy. Licenses and Certifications: - BLS-Basic Life Support Healthcare Provider - American Heart Association/American Red Cross/National Safety Council required - + one of the following: - N/A - License RN-Registered Nurse (30) - State of Wisconsin - License RN-Registered Nurse (IN Compact) - State of Indiana - License RN-Registered Nurse (AZ Compact) - State of Arizona Patient Care Responsibility - Provides care appropriate to patient population and as described in applicable policies and procedures. Required for All Jobs: - This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job. - Employment is at-will. This document does not create an employment contract, implied or otherwise. Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

Hospice

Full-time

1 week ago

RN Patient Care Manager - Hospice

BrightSpring Health Services Waterford, WI

Our Company Allay Hospice Overview $5K Sign-On Bonus Location: Waterford, WI Coverage Area: Waterford ( Racine, Kenosha, Walworth and southeastern Milwaukee Cty) Schedule Information: M-F 8am -5pm Status: Full-Time Lead with Compassion as an RN Patient Care Manager Our Hospice RN Patient Care Managers are the cornerstone of our care teams, ensuring patients receive the best possible support while coaching and guiding our clinical staff. Join a team of highly skilled professionals committed to delivering meaningful care every day. Make a positive impact from day one—apply now! What We Offer: Medical & Dental Insurance Short‑ & Long‑Term Disability Life Insurance Paid Time Off (PTO) 401(k) Retirement Program Flexible Spending Account (FSA) Employee Assistance Program (EAP) Vendor Discounts Responsibilities Receiving and reviewing case referrals to determine needs, and assigning appropriate hospice personnel to case Reviewing patient medical diagnosis, prognosis, medications, procedures and clinical course Assisting clinicians in developing plans of care and guiding clinicians to promote more effective performance and delivery of quality services Facilitating coordination of care and discussion with interdisciplinary group Conducting quarterly record reviews and communicating findings with Director of Clinical Operations and/or Executive Director Supervising hospice clinical personnel, including hiring and assisting in new employee orientation and assisting in coordination of continuing education programs Participating in quality assessment performance improvement teams and activities Ensuring compliance with all state and federal legal and regulatory requirements Additional responsibilities as assigned . Qualifications Registered Nurse with current licensure to practice in state of operation, BSN preferred Hospice or home care experience preferred 2+ years management or supervisory experience Excellent observation, nursing judgment and communication skills Knowledge of the hospice philosophy of care and principles of pain/symptom management Commitment to clinical and documentation excellence About our Line of Business At Allay Hospice, our primary ambition is to bring first-class care to the warmest and most serene environment possible: home. We provide the full spectrum of hospice services, thoughtfully tailored to the individual needs of patients and families. Allay Hospice, an affiliate of BrightSpring Health Services, is grounded in a foundational commitment to providing exceptional patient care and championing our agency leadership and teams. We are proud to have experts in the health care industry on our team. We are confident you will find purpose, meaning and a chance to make a positive impact from day one. For more information, please visit www.allayhh.com. Follow us on Facebook and LinkedIn.

Outpatient

Full-time

2 months ago

Clinic RN - Waterford Clinic - Primary Care Phone Triage & Nurse Visits

ProHealth Care Waterford, WI

Clinic RN – Days (Primary Care Triage) | Waterford 1.0 FTE Begin your story with ProHealth Medical Group. We are seeking a Clinic RN to join our Waterford primary care team. This full-time, day-shift role offers a consistent weekday schedule and the opportunity to focus on phone triage, nurse visits, and patient education in a collaborative clinic environment. Schedule Monday through Friday, 8:00 a.m. to 4:30 p.m. What you’ll do This role supports primary care patients through clinical phone triage, nurse visits, and care coordination. You’ll work closely with providers and clinic staff to ensure patients receive timely, high-quality care. Responsibilities include • Clinical phone triage and patient assessment • Nurse visits and patient education • Care coordination and follow-up • Collaboration with providers and care teams • Cross-training opportunities in lab services and urgent care support, based on clinic needs If you’re an RN who values predictable hours, meaningful patient interaction, and a supportive ambulatory care setting, we’d love to connect with you. What You Will Do: The Clinic RN in the Medical Group utilizes the nursing process to deliver appropriate nursing care and procedures in the clinic setting. The Clinic RN performs nursing acts delegated by a physician, physician assistant or nurse practitioner. This individual oversees and acts as a professional clinical resource for the Medical Assistant/Clinic LPNs and other ancillary professionals. Act as the resource for data gathering and assessment, triage walk-in and call-in patients to the appropriate health care provider. What You Will Need: Registered Nurse in the State of Wisconsin Associate’s Degree in Nursing (ADN) Minimum of 2 years of clinical experience in primary care clinic environment or 3-5 years clinical hospital, home care, or community health experience Basic Life Support (BLS) card through the American Heart Associate (AHA), or ability to obtain certification upon hire About Us: ProHealth Care is an equal opportunity employer and is committed to an inclusive work environment and values the perspectives of our people. We maintain a drug-free workplace and perform pre-employment substance abuse testing. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

Urgent Care

Part-time

3 weeks ago

Registered Nurse (RN) - Urgent Care

Advocate Aurora Health Mukwonago, WI

$35.50 - $53.25 / hour

Department: 02190 AMG Mukwonago - Immediate Care Status: Part time Benefits Eligible: Yes Hou rs Per Week: 20 Schedule Details/Additional Information: Urgent Care hours 8-8 weekdays, Weekends and Holidays 8-4. Rotating shifts. Must be willing to work 3 weekend shifts a month and 1-2 Friday nights. Experience in Emergency or Urgent Care preferred. Pay Range $35.50 - $53.25 Major Responsibilities: Engages in unit councils, professional governance, and quality initiatives to improve care processes and apply evidence-based practices. Utilizes the nursing process to assess, plan, diagnose, implement, and evaluate nursing care, engaging patients and families through the continuum of care. Monitors patient conditions, adjusts care plans, mobilizes resources, and collaborates with the care team to influence care outcomes. Upholds and promotes a culture of safety. Continuously evaluates patient, team, and unit outcomes, taking action as needed. May administer medications, treatments, and therapies safely and according to clinical protocols and procedures. Demonstrates effective communication, feedback, and conflict resolution, fostering team collaboration and appropriate delegation. Pursues professional development, completes required education, and maintains certifications. Adhere to the ANA Code of Ethics and practices ethical decision-making, respects interdisciplinary roles, and contributes to integrated, unbiased patient care. Appropriate delegation to other Registered Nurses, Licensed Practical Nurses, and unlicensed assistive personnel (i.e., nurse aides, credentialed medical assistants, etc.). Maintains accurate, timely EHR documentation. May be required to float to other units, departments, care areas, or facilities within the designated service area to meet patient care needs. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards. Minimum Job Requirements Education Graduate of a Board of Nursing approved nursing education program. Certification / Registration / License Basic Life Support (BLS). Additional education, training, certifications, or experience may be required based on specialty. Active, unrestricted registered nurse (RN) multi-state compact and/or single-state license with privileges to practice in the state(s) where the RN is providing client nursing services Note : Licensed nurses practicing via telehealth/telenursing/virtual modalities are required to be licensed or hold the privilege to practice in the state(s) where the client(s) is/are located. Licensed nurses are responsible and accountable for knowing, understanding, and practicing in compliance with the laws, rules, regulations, and standards of practice of the state(s) where the client(s) is/are located. Experience Typically requires 1 year of experience in clinical nursing. Knowledge / Skills / Abilities Strong clinical judgment and critical thinking. Time management, prioritization and problem-solving skills. Excellent communication and interpersonal skills. Ability to work in a fast-paced, dynamic environment. Proficiency in operating computer functions (e.g., E-mail, electronic records, digital platforms etc.) clinical, aviation, maintenance, communications, and administrative departments. Physical Requirements and Working Conditions Must be able to sit, stand, walk, lift, squat, bend, reach above shoulders, and twist frequently throughout the workday. Must be able to lift and support the weight of 35 pounds in handling patients, medical equipment, and supplies. Must be able to: push/pull with 30 lbs. of force and perform a sliding transfer of 150 lbs. with a second person present. Must have functional speech, vision, hearing, and touch with ability to use fine hand manipulation skills for IV insertion and other procedures/functions. Maneuver foot pedals on carts or machines. Perform physical safety interventions such as patient restraint and verbal de-escalation, if needed. May be exposed to chemical and hazardous waste as well as blood and body fluids and communicable disease. Therefore, protective clothing and equipment must be worn as necessary. Must be able to respond quickly to changes in patient and/or unit conditions. Physical Abilities Testing may be required. Additional department specific physical requirements may be identified for unique responsibilities within the department by the nurse leader. Preferred Job Requirements Education Bachelor of Science degree in Nursing (BSN) This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Clinic RN - Delafield Urgent Care Clinic - Part Time Every Other Weekend

ProHealth Care Delafield, WI

Clinic RN – Delafield Urgent Care (.5 FTE, PMs) At ProHealth Care’s Delafield Clinic, our Urgent Care team provides immediate care to patients of all ages, treating everything from fevers and earaches to sprains and minor injuries. This is your chance to join a collaborative group that thrives in a fast-paced environment while delivering compassionate, patient-centered care. Schedule This is a part-time role with benefits (0.5 FTE) that offers a consistent and balanced rotation: Week 1 : Sunday 8:00 a.m.–4:00 p.m.; Tuesday–Thursday 4:00–8:00 p.m. Week 2 : Tuesday–Friday 4:00–8:00 p.m.; Saturday 8:00 a.m.–4:00 p.m. This schedule is a great fit for RNs looking for steady hours in the evenings with every other weekend off, leaving mornings and many weekdays free offering work life balance. Why you’ll love working here A supportive, team-oriented culture where your voice is valued The chance to practice a wide scope of nursing skills with patients of all ages Predictable, lifestyle-friendly hours that help you balance work and life Competitive pay and benefits, including health vision and dental plans, PTO, tuition reimbursement, and 401(k) match Be part of a team that’s trusted by the community and supported by the resources of a leading regional health system. Begin your story with ProHealth Care. Job Summary Utilizes the nursing process to deliver appropriate nursing care and procedures in the clinic setting. Performs nursing acts delegated by a physician, physician assistant or nurse practitioner. Oversees and acts as a professional clinical resource for the Medical Assistant/Clinic LPNs and other ancillary professionals. Act as the resource for data gathering and assessment, triage walk-in and call-in patients to the appropriate health care provider. Established protocols and processes will provide a consistent systematic framework for decision-making and positive patient outcomes. Responsibilities • Performs the duties of a R.N. in accordance with the Nursing Code of Ethics, The Nurse Practice Act of the State of Wisconsin and PHCMA Nursing policies. • Provides health care advice to patients and family members utilizing the nursing process and triage protocols, makes nursing decisions and develops a plan of care based on a phone triage assessment and directs patients to the appropriate healthcare provider / facility. • Completes all documentation accurately, timely and efficiently for regulatory compliance and accurate billing. Follows protocol and routes documents to provider as required. Demonstrates skills necessary for proper documentation in the Electronic Health Record. • Administers medications appropriately using the “5 rights” of administration and “2 identifier system” for proper patient verification. • Performs therapeutic treatments and other health screenings as required by the provider or specialty area. • Administers IV’s according protocol • Make sure exam rooms and procedure areas are clean, orderly and meet organizational and regulatory compliance standards. • Assist physician/providers with procedures using sterile techniques. • Collect / obtain blood, urine or other specimens from patients as needed for patient care. • Assist with splinting, casting or orthopedic appliance fitting when applicable to the role. • Responds to urgent and emergency patient care situations as required under RN nursing practice. • Assists in the control and maintenance of clinic medications, supplies and equipment. Report low supplies, expired supplies and necessary equipment repairs to clinic leadership. Records the use of medications maintaining counts and controls. • Facilitate process for outpatient services, emergency department transfers and hospital admission for the patient and document as necessary. • Performs patient teaching and discharge instructions adhering to the documentation and provision of the after visit summary. • Makes follow up calls to patients under the direction of established protocol and as directed by the physician/provider • Reviews test results and responds appropriately to provider, patient and others involved in care • Maintains and provides patient education materials • Monitors patient needs for prescription refills, follows required protocol with physician/provider What You Will Do: The Clinic RN in the Medical Group utilizes the nursing process to deliver appropriate nursing care and procedures in the clinic setting. The Clinic RN performs nursing acts delegated by a physician, physician assistant or nurse practitioner. This individual oversees and acts as a professional clinical resource for the Medical Assistant/Clinic LPNs and other ancillary professionals. Act as the resource for data gathering and assessment, triage walk-in and call-in patients to the appropriate health care provider. What You Will Need: Registered Nurse in the State of Wisconsin Associate’s Degree in Nursing (ADN) Minimum of 2 years of clinical experience in primary care clinic environment or 3-5 years clinical hospital, home care, or community health experience Basic Life Support (BLS) card through the American Heart Associate (AHA), or ability to obtain certification upon hire About Us: ProHealth Care is an equal opportunity employer and is committed to an inclusive work environment and values the perspectives of our people. We maintain a drug-free workplace and perform pre-employment substance abuse testing. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability. *CA #CA #LI