NICU Care Manager, Telephonic Nurse

NICU Care Manager, Telephonic Nurse 2

Become a part of our caring community and help us put health first. The NICU Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates members' 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 NICU Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Location: Remote

Humana is seeking a NICU Care Manager, Telephonic Nurse 2 who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria. You will follow our tiniest members from the beginning of their NICU stays until discharge! You will be identifying and utilizing appropriate healthcare resources most consistent with the member's needs and by providing guidance along the healthcare continuum. You will perform clinical case review on members during an inpatient hospital admission. You will collaborate with other health care providers in reviewing actual and proposed medical care and services. You will work to assess care needs, assist in coordinating interventions and services to meet those needs, and communicating with providers and Humana associates to promote efficient use of the healthcare system.

Please note this is a fast-paced role with lots of moving parts which will require a candidate that is organized, hardworking and quick to learn.

Responsibilities:

• Provide authorizations for inpatient stay.
• Provide care coordination and discharge planning.
• Provide home health and medical equipment coordination.
• Partner with facilities to support superior care.

Hours of operation are Monday through Friday 8:30-5 p.m. EST OR CST. This role will require on call for rotating holidays and weekends. Please note training may be conducted in an alternate time zone virtually.

Required Qualifications:

• Registered Nurse (RN) with 3 years or more of NICU level 3 experience.
• Active Compact RN license with the ability to apply for additional licensure without restrictions if needed.
• Ability to work independently under general instructions and with a team.
• Team player.
• Strong organizational skills and experience multi-tasking.

Preferred Qualifications:

• BSN or Bachelor's degree in a related field.
• Health Plan experience.
• Previous experience in utilization management, discharge planning and/or home health or rehab.
• Bilingual is a plus preferably Spanish.
• Clinical claim review experience.

Work At Home / Internet Information:

• 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.

SSN Alert:

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.

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 $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.

Application Deadline: 11-07-2025

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.