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Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in comprehensive case management for complex medical cases, ensuring integrated care plans that address beneficiary needs while coordinating with various healthcare providers. Holds an active RN license and is capable of obtaining CCM certification, with a strong background in clinical and managed care settings.
Highest-signal resume keywords
Active RN LicenseCase Management ExperienceCCM CertificationTRICARE ExperienceMCG Experience
About the role
Key responsibilities & impact- Provide comprehensive, holistic case management for complex medical cases throughout the continuum of care
- Deliver specialized interventions using appropriate care sites and levels of care
- Prevent or decrease hospital readmissions
- Promote appropriate utilization of alternative funding sources
- Enhance coordination of care and reduce fragmentation of clinical services
- Serve as the beneficiary's point of contact for activities across the clinical spectrum
- Coordinate with Care Management programs, Military Treatment Facility utilization management and case management staff, and providers
- Ensure fully integrated care plans address all beneficiary needs and conditions
- Report to a Manager of Care Management
Requirements
What you’ll need- U.S. citizenship required for the Department of Defense contract
- Successfully receive interim approval for government security clearance (NBIS)
- Cannot currently live in Puerto Rico
- Active RN license in state of employment
- Ability to obtain CCM certification within 1 year of hire
- 2 years of case management experience
- 3 years of clinical RN or managed care RN experience
- Must work Monday–Friday, either 8 a.m.–5 p.m. ET or 9 a.m.–6 p.m. ET
- Bachelor's degree in nursing preferred
- TRICARE experience preferred
- Experience with MCG preferred
- Current CCM preferred
- Home internet with at least 25 Mbps download and 10 Mbps upload
- Dedicated workspace without ongoing interruptions to protect PHI/HIPAA information
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Dedicated home workspace and internet requirements for remote work
- Occasional travel to Humana offices for training or meetings
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case ManagementClinical RN ExperienceManaged Care RN ExperienceCare CoordinationIntegrated Care Plans
Soft Skills
CommunicationCoordinationProblem-Solving
Certifications & Qualifications
CCM Certification
Industry Keywords
Continuum of CareHospital ReadmissionsAlternative Funding SourcesMilitary Treatment FacilityPHI/HIPAA Compliance