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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case management, ensuring comprehensive care coordination and effective interventions across various clinical settings. Holds an active RN license and is capable of obtaining CCM certification, with a strong background in TRICARE and MCG.
Highest-signal resume keywords
Active RN LicenseCCM CertificationCase Management ExperienceClinical RN ExperienceTRICARE Experience
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 ManagementCare CoordinationClinical Services IntegrationHospital Readmission PreventionCare Plan Development
Soft Skills
CollaborationCommunicationInterpersonal Skills
Tools & Technologies
MCG
Certifications & Qualifications
CCM Certification
Industry Keywords
TRICAREManaged CarePHI/HIPAA ComplianceGovernment Security ClearanceContinuum of Care
About the role
Key responsibilities & impact- Provide comprehensive, holistic case management throughout the continuum of care
- Deliver specialized case management interventions using appropriate care sites and levels of care
- Prevent or reduce hospital readmissions
- Promote appropriate utilization of alternative funding sources
- Enhance coordination of care and reduce fragmentation of clinical services
- Serve as the point of contact for beneficiaries across the clinical spectrum within the complex case management program
- Coordinate and collaborate with Care Management programs, Military Treatment Facility staff, physicians, 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
- Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
- Candidates currently living in Puerto Rico cannot be hired
- 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
- Bachelor's degree in nursing preferred
- TRICARE experience preferred
- Experience with MCG preferred
- Current CCM preferred
- Ability to work an 8-hour shift between 8:00 a.m. and 6:00 p.m. EST, Monday–Friday
- Mandatory training availability from 8:00 a.m. to 5:00 p.m. EST for the first 4 weeks
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Dedicated workspace without ongoing interruptions to protect member 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 leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Personal wellness and smart healthcare decision support
- Remote work arrangement
- Home internet service support/requirements for remote work
- Occasional travel to Humana offices for training or meetings