Become a part of our caring community and help us put health first The Field Care Manager Nurse 2 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 Field Care Manager Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. How we value you! - Competitive Pay, including eligibility for annual performance-based bonus - Employee Referral Program The Field Care Manager Nurse employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psychosocial health needs. - Must reside in Michigan with the ability to drive to Wayne and/or Macomb Counties. - This position is based out of a home office and requires traveling 75–90% of the time within an assigned area in Wayne and/or Macomb County to conduct in‑home visits with Medicare/Medicaid members. Position Responsibilities: - The RN Field Care Manager will be responsible for managing a caseload and completing assessments with members in their home or community‑based setting, as well as telephonically. - Provides clinical support and guidance, particularly for members with medical complexity. Helps develop and coordinate care plans, ensuring that members receive appropriate services to manage their health needs effectively. Addresses barriers to care and advocates for optimal member outcomes. - Reviews, assesses, and completes medical complexity attestations and clinical oversight activities. - Ensures members receive services in the least restrictive setting to achieve and/or maintain optimal well‑being by assessing their care needs. - Develops and modifies the Individual Care Plan and involves applicable members of the care team (informal caregiver, coach, PCP, etc.) in the care‑planning process. - Focuses on supporting members and/or caregivers using an interdisciplinary approach to access social, housing, educational, and other services—regardless of funding source—to meet identified needs. - Serves as the primary point of contact for the Interdisciplinary Care Team (ICT) and is responsible for coordinating with the member, ICT participants, and external resources to ensure the member’s needs are met. Use your skills to make an impact Required Qualifications - Must reside in the state of Michigan (Wayne or Macomb Counties) - Active Michigan license as a Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN), including Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS), with no disciplinary action - 2+ years' experience in Health Care and/or Case Management - Ability to travel to homes and community settings for face-to-face assessments - Experience working with the adult population, disease management. - Knowledge of community health and social service agencies and additional community resources - Ability to use a variety of electronic information applications & software programs including electronic medical records - Excellent keyboard and web navigation skills - Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel Preferred Qualifications - BSN - Experience with in home assessment and care coordination experience - Experience with health promotion, coaching and wellness - Experience with Medicaid Long Term Care - Previous managed care experience - Bilingual- Spanish, Arabic or Chaldean Neo-Aramaic - Certification in Case Management - Motivational Interviewing Certification and/or knowledge Additional Information · Schedule/Time Zone: Monday through Friday, 8:30 AM – 5:00 PM Eastern Time Zone · Work Location: Michigan (Wayne and Macomb Counties) · Work Style: Field · Travel Requirements: 75%- 90% travel within Wayne and/or Macomb Counties, MI) Work-at-Home (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. TB Statement: This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Driving Statement: This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.  Eligible mileage includes: - Travel from your home to your first work location of the day. - Travel between client or assignment locations during the workday. - Travel from your final work location back to your home. Interview Format: 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. Language Assessment Statement: Any Humana employee who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 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 Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large. ​ 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.

• Responsible for assigned aspects of medical policies and programs • Performs medical reviews and interacts with the provider communities for assigned areas

• rely on medical background and review health claims • provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards • make decisions on moderately complex to complex issues regarding technical approach for project components • exercise considerable latitude in determining objectives and approaches to assignments

• providing clinical expertise to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy • transactional reviews in support of the appeal process • clinical claim review process • predetermination of covered benefits in the Commercial and Medicare environments • participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve quality and efficiency of health care services • apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests • proactively use data analysis to identify opportunities for quality improvement