Divisional RN Care Navigator - Remote Houston

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

The RN Care Navigator assesses and 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 RN Care Navigator work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The RN Care Navigator employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues.

Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and / or evaluations.

May create member care plans. 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, and requires minimal direction and receives guidance where needed.

Follows established guidelines / procedures.

Major Duties and Responsibilities

• Conduct Transitions of Care Management for a subset of the patient population, including ER and hospital follow ups
• Provide triage guidance and supportive consultation to other team members, handling escalated complex cases
• Develop care plans leveraging 5Ms Geriatric best practice framework
• Develop a wholistic view of patient needs related to Social Determinants of Health

Review mental, physical, social needs to trigger collaborative supports such as LCSWs, CHWs, MSWs, and pharmacists.

• Identify existing barriers to engagement with necessary resources and supports
• Provide education around maintenance of chronic health conditions, as well as available options for behavioral care and social support
• Serve as liaison between the patient and the direct care providers, assisting in navigating both internal and external systems
• Initiate care planning and subsequent action steps for high-risk members, coordinating with interdisciplinary team
• Supporting patients’ self-determination, motivate patients to meet the health goals they have identified
• Refer patient to necessary services and supports
• Lead Interdisciplinary Team Meetings when indicated
• Assess patient’s family system, and conduct family meetings with patient and family when needed
• Participate in creation and facilitation of team training content
• Conduct group psychoeducation and support groups within the Center as needed via ZOOM
• Perform all other duties and responsibilities as required
• Participate in and lead interdisciplinary review of and coordination around complex patients
• Maintain patient confidentiality in accordance with HIPAA
• Document patient encounters in medical record system in a timely manner

Use your skills to make an impact

Required Qualifications

Active Compact Licensed Registered Nurse

Role is remote, but candidates must live in Houston area

2 years of experience of case / care management

The National Council of State Boards of Nursing (NCSBN) developed the Nursing Licensure Compact (NLC), which is an agreement between states that allows nurses to have one license and the ability to practice in all the states that participate in the program.

License must be current with no disciplinary action.

Openness to applying for temporary licensure if needed for other states.

Minimum of 4 years of experience working in human services and navigating community-based resources

Experience working with the adult population

Knowledge of community health and social service agencies and additional community resources

Ability to travel to member's residence within 30 to 40 miles

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

Excellent keyboard and web navigation skills

Ability to work a full-time (40 hours minimum) flexible work schedule

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.

Must have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you work

Must have accessibility to high-speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role);

and recommended speed for optimal performance from Humana At Home systems if 5Mx1M

This role is considered patient facing and is part of Humana At Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Valid driver's license, car insurance, and access to an automobile

Associates working in the State of Florida will need ACHA Level II Background clearance

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Familiarity with state Medicaid guidelines and application processes

Experience working with patients with behavioral health conditions and substance use disorders

Prior experience working with collaborative care teams

Ability to speak easily to providers, MDs, NPs

3-5 years of in-home assessment and care coordination experience

Experience with health promotion, coaching and wellness

Previous managed care experience

Bilingual English, Spanish

Certification in Case Management

Motivational Interviewing Certification and / or knowledge

Additional Information

Skills / Abilities / Competencies Required

Advanced clinical acumen

Ability to multi-task in a fast-paced work environment

Flexibility to fluidly transition and adjust in an evolving role

Excellent organizational skills

Advanced oral and written communication skills

Strong interpersonal and relationship building skills

Compassion and desire to advocate for patient needs

Critical thinking and problem-solving capabilities

Working Conditions

This role is remote. Interaction with clinics, meetings, educational groups can be conducted via ZOOM.

Benefits

Health benefits effective day 1

Paid time off, holidays, volunteer time and jury duty pay

Recognition pay

401(k) retirement savings plan with employer match

Tuition assistance

Scholarships for eligible dependents

Workstyle : work from home; occasional clinic visits where location permits

Location : Must reside within the Houston TX area

Hours : Must be able to work a 40-hour work week, Monday through Friday 8 : 00 AM to 5 : 00 PM, over-time may be requested to meet business needs.

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.

$69,800 - $96,200 per yearThis 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 CenterWell Senior Primary Care : CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more.

Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being.

Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes.

We go beyond physical health by also addressing other factors that can impact a patient’s well-being.About CenterWell, a Humana company : CenterWell creates experiences that put patients at the center.

As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients.

As part of Humana Inc. (NYSE : HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career.

We proudly employ more than 30,000 clinicians who are committed to putting health first for our teammates, patients, communities and company.

By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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 because he or she is a protected veteran.

It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.