RN Case Manager, Miramar

Job Description: Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly traded health benefits companies, with approximately 9 million medical members. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Over its 45-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.


Works with members to assess their care needs, assist in planning and implementation of interventions to meet those needs, assists in coordinating services, and monitors and periodically evaluates the case management plan against the member's personal health care goals. Document this case management process in the appropriate systems as defined by management.

Collaborates with the member's provdier team to monitor provider-based care and discharge planning at all levels of care in accordance with established criteria and meakes recommendations to improve such efforts where appropriate. Utilizes knowledge of benefit plan design and care alternatives available within the community and nationally in order to recommend services.

Identifies candidate for specific disease management activities or interventions by utilizing established screening criteria.

Maintains an awareness of clinical and social resources available in the community in which the member resides.

Performs duties consistent with all State and Federal regulatory requirements, accreditation organization guidelines, and Humana guidelines.

Searchable Keywords: RN Case manager Miramar / gj-mo

Minimum Education Required: Associate

Years of Experience Required: 3-5 Years

Expected Travel Time: None