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case management supervisor

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case manager rn - work from home - mst or pst Jobs in Washington

claims case manager

case manager rn work from home mst or pst

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary:
This RN Case Manager position is 100% remote and candidates are required to live PST or MST. Preference is for an RN with Compact RN licensure.
Normal Working Hours: Monday through Friday 8am-5pm in time zone of residence with requirement to flex time to meet member/business needs.
The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate overall wellness.
RN Case Manager:
&ndash; Collaboratively develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member&rsquo;s overall wellness through integration.
&ndash; Through the use of clinical tools and information/data review (e.g., assessments, claims, etc..) conducts an evaluation of member&rsquo;s needs and available benefits to collaborate and refer to programs offered by the plan sponsor.
&ndash; Applies clinical judgment to reduce risk factors, address complex health issues and social indicators.
&ndash; Utilizes case management processes in compliance with regulatory and company policies and procedures.
&ndash; Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Please note:<ul><li>This role involves using a computer station with multiple screens, operating multiple programs simultaneously, and sitting for extended periods of time.</li><li>A private designated workspace free of distractions and high-speed internet is needed for this position.</li></ul>
Required Qualifications:<ul><li>Must have an active and unrestricted RN license in state of residence, preferably compact</li><li>RN living in MST, or PST Time Zone</li><li>Willingness and ability to obtain additional state licenses upon hire (paid for by the company)</li><li>3+ years of acute care clinical experience as an RN (general medical, post-surgical, specialty including pediatrics, ICU, case management and discharge planning)</li></ul>
Preferred Qualifications:<ul><li>Compact RN licensure</li><li>1+ years of case management experience</li><li>Certified Case Manager (CCM) certification</li><li>Strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues.</li><li>Experience with all types of Microsoft Office including PowerPoint, Excel, and Word</li><li>Strong telephonic communication skills</li><li>1+ years of experience utilizing computers and navigating multiple monitors while speaking with someone on the telephone.</li><li>Transgender certification</li></ul>
Education:<ul><li>Associates in nursing</li><li>BSN</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$66,575.00 - $142,576.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits &ndash; investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul><li>
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li><li>
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li><li>
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li></ul>
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 03/28/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Case Manager RN - Work From Home - MST or PST

Included Health

<div>
 We're looking for a Newborn/Pediatric Nurse Care Manager for our Care and Case Management team, who is passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading interventions. The telephonic Nurse Care Manager will guide members through complex Medical and Behavioral Health situations, partnering with a diverse clinical team that includes a variety of healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care in a creative way. The Nurse Care Manager should enjoy spending time on the phone, listening to members' needs, answering questions, and serving as an advocate. You should also excel at creating cohesive care plans, and should have the clinical skills to guide members clinically and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes.
 
 
 
 Schedule: Monday-Friday 9am-6pm PST
 
 
 
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Deliver coordinated, patient-centered virtual Care Management by telephone and video that improves members' health outcomes.
 </li>
 <li>
 Create impactful care plans together with members and our diverse care team, and help members achieve the desired goals.
 </li>
 <li>
 Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
 </li>
 <li>
 Partner with the members' local providers to ensure coordinated care.
 </li>
 <li>
 Provide compassionate, longitudinal follow-up care, building supportive relationships.
 </li>
 <li>
 Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
 </li>
 <li>
 Coordinate necessary resources that holistically address members' problems, whether clinical or social
 
 
 </li>
 </ul>
 
 Required Qualifications
 
 
 
 <ul>
 <li>
 Bachelor of Science in Nursing (BSN).
 </li>
 <li>
 Must have current CCM Certification or eligibility within 6 months of hire
 </li>
 <li>
 5+ years of experience in nursing
 </li>
 <li>
 2+ years experience working in care management
 </li>
 <li>
 Must reside in a compact NLC state.
 </li>
 <li>
 Active Compact RN license in good standing with the nursing board of their state.
 </li>
 <li>
 Willingness to become (and maintain) licensure in multiple states.
 </li>
 <li>
 Work 9AM-6pm PST (Preference for those based in MST/PST time zones)
 </li>
 <li>
 Be comfortable discussing several medical conditions and experience with populations across the age ranges
 </li>
 <li>
 Spanish speaking desirable
 </li>
 <li>
 Experience working remotely, and strong competence and ability to use multiple computer/medical record systems.
 </li>
 <li>
 Be empathetic. We work with patients and their families who are going through challenging times. You practice empathy and reassure patients that we are available to help them.
 </li>
 <li>
 We are a fast-growing company and we are busy. Our team will meet volume goals without sacrificing quality.
 </li>
 <li>
 Strictly follow security and HIPAA regulations to protect our patients' medical information.
 </li>
 <li>
 Be pleasant, responsive, and willing to work with and learn from our team.
 </li>
 <li>
 A lot of time is spent on the phone with patients and families, and a lot of time communicating with colleagues. Therefore, the ability to gather a clinical history, answer questions at a patient level, and summarize findings is critical.
 </li>
 <li>
 Efficient at writing medical information in easy-to-understand, patient-centric language.
 
 
 </li>
 </ul>
 The United States new hire base salary target range for this full-time position is:
 
 
 $73,700 - $103,180 + equity + benefits
 
 
 This range reflects the minimum and maximum target for new hire salaries for candidates. Below is additional information on Included Health's commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.
 
 
 Starting base salary for the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and competitive compensation based on their roles and locations.
 
 Your Recruiter can share your geographic zone alignment upon inquiry.
 
 
 
 In addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following:
 
 
 Remote-first culture
 
 
 401(k) savings plan through Fidelity
 
 
 Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)
 
 
 Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents
 
 
 Generous Paid Time Off ("PTO") and Discretionary Time Off ("DTO")
 
 
 12 weeks of 100% Paid Parental leave
 
 
 Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy &amp; Adoption financial assistance
 
 
 Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)
 
 
 11 Holidays Paid with one Floating Paid Holiday
 
 
 Work-From-Home reimbursement to support team collaboration and effective home office work
 
 
 24 hours of Paid Volunteer Time Off ("VTO") Per Year to Volunteer with Charitable Organizations
 
 .
 
 
 
 
 About Included Health
 
 
 
 Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We&rsquo;re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community &mdash; no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It&rsquo;s all included. Learn more at
 
 includedhealth.com.
 
 
 
 Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.
 
 
 Included Health uses AI-assisted tools at select stages of the hiring process to enhance efficiency, consistency, and communication. AI does not make hiring decisions&mdash;final decisions are made exclusively by our recruiting and hiring teams.
</div>

Pediatric Nurse Care Manager

<div>
 We're looking for Oncology Nurse Care Managers for our Care and Case Management team, who are passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading interventions. As a telephonic Nurse Care Manager you will report to the Manager, Care and Case Management and will guide members through complex medical and behavioral Health situations, partnering with a diverse clinical team that includes a variety of healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care in a creative way. The Nurse Care Manager should enjoy spending time on the phone, listening to members' needs, answering questions, and serving as an advocate. You will excel at creating cohesive care plans, and have the clinical skills to guide members clinically and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes.
 
 
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Deliver coordinated, patient-centered virtual Care Management by telephone or video that improves members' health outcomes.
 </li>
 <li>
 Create impactful care plans together with members and our diverse care team, and help members achieve the desired goals.
 </li>
 <li>
 Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
 </li>
 <li>
 Partner with the members' local providers to ensure coordinated care.
 </li>
 <li>
 Provide compassionate, longitudinal follow-up care, building supportive relationships.
 </li>
 <li>
 Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
 </li>
 <li>
 Coordinate necessary resources that holistically address members' problems, whether clinical or social
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Bachelor of Science in Nursing (BSN) required
 </li>
 <li>
 Oncology experience highly preferred
 </li>
 <li>
 5+ years of experience in nursing
 </li>
 <li>
 2+ years experience working in care management
 </li>
 <li>
 Must reside in a compact NLC state.
 </li>
 <li>
 Active Compact RN license in good standing with the nursing board of their state.
 </li>
 <li>
 Willingness to become (and maintain) licensure in multiple states.
 </li>
 <li>
 Work until 9-6PM PST
 </li>
 <li>
 Be comfortable discussing several medical conditions and experience with populations across the age ranges
 </li>
 <li>
 Spanish speaking desirable
 </li>
 <li>
 Experience working remotely, and strong competence and ability to use multiple computer/medical record systems.
 </li>
 <li>
 Be empathetic. We work with patients and their families who are going through challenging times. You practice empathy and reassure patients that we are available to help them.
 </li>
 <li>
 We are a fast-growing company and we are busy. Our team will meet volume goals without sacrificing quality.
 </li>
 <li>
 Strictly follow security and HIPAA regulations to protect our patients' medical information.
 </li>
 <li>
 Be pleasant, responsive, and willing to work with and learn from our team.
 </li>
 <li>
 A lot of time is spent on the phone with patients and families, and a lot of time communicating with colleagues. Therefore, the ability to gather a clinical history, answer questions at a patient level, and summarize findings is critical.
 </li>
 <li>
 Efficient at writing medical information in easy-to-understand, patient-centric language.
 
 
 </li>
 </ul>
 
 Physical/Cognitive Requirements
 
 
 
 <ul>
 <li>
 Prompt and regular attendance at assigned work location.
 </li>
 <li>
 Capability to remain seated in a stationary position for prolonged periods.
 </li>
 <li>
 Eye-hand coordination and manual dexterity to operate keyboard, computer and other office-related equipment.
 </li>
 <li>
 No heavy lifting is expected, though occasional exertion of about 20 lbs of force (e.g., lifting a computer \/ laptop) may be required.
 </li>
 <li>
 Capability to work with leadership, employees, and members in an appropriate manner.
 
 
 </li>
 </ul>
 The United States new hire base salary target range for this full-time position is:
 
 
 $73,700 - $103,180 + equity + benefits
 
 
 
 This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health's commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.
 
 
 
 
 Starting base salary for you will depend on several job-related factors, unique to each candidate, which may include education; training; skills; years and depth of experience; certifications and licensure; our needs; internal peer equity; organizational considerations; and understanding of geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and great compensation package based on their roles and locations. Your Recruiter can share your geographic zone upon inquiry.
 
 
 
 
 Benefits &amp; Perks
 
 
 
 
 In addition to receiving a great compensation package, the compensation package may include, depending on the role, the following and more:
 
 
 
 
 Remote-first culture
 
 
 
 
 401(k) savings plan through Fidelity
 
 
 
 
 Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)
 
 
 
 
 Paid Time Off ("PTO") and Discretionary Time Off ("DTO")
 
 
 
 
 12 weeks of 100% Paid Parental leave
 
 
 
 
 Family Building &amp; Compassionate Leave: Fertility coverage, $25,000 for surrogacy/adoption, and paid leave for failed treatments, adoption or pregnancies.
 
 
 
 
 Work-From-Home reimbursement to support team collaboration home office work
 
 
 
 
 Your recruiter will share more about the salary range and benefits package for your role during the hiring process.
 
 
 
 
 About Included Health
 
 
 
 Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We&rsquo;re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community &mdash; no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It&rsquo;s all included. Learn more at
 
 includedhealth.com.
 
 
 
 Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.
 
 
 Included Health uses AI-assisted tools at select stages of the hiring process to enhance efficiency, consistency, and communication. AI does not make hiring decisions&mdash;final decisions are made exclusively by our recruiting and hiring teams.
 
 
</div>

Oncology Nurse Care Manager, Adult

Lutheran Social Services of the National Capital Area

<div>Position Summary
The Case Manager provides intensive, evidence-based home visiting services to pregnant and postpartum parents and their families to improve maternal and child health, strengthen parent-child relationships, and promote family self-sufficiency. The Case Manager delivers trauma-informed, culturally responsive, and strengths-based services, including assessments, care coordination, counseling, referrals, and advocacy.
Key Responsibilities
Direct Client Services<ul><li>
Provide regular home visits to program participants, delivering education and coaching on prenatal care, infant/child health, breastfeeding, parenting, nutrition, and safe sleep.</li><li>
Conduct comprehensive assessments (health, psychosocial, safety, developmental) for mothers, infants, and families.</li><li>
Develop and monitor individualized service plans tailored to client needs and goals.</li><li>
Offer counseling and support around perinatal mood disorders, stress management, and family strengthening.</li><li>
Connect families with medical homes, mental health providers, social services, housing, employment, and educational resources.</li></ul>
Documentation &amp; Compliance<ul><li>
Maintain accurate, timely case notes and data in the electronic record system in compliance with federal, state, and local program requirements.</li><li>
Complete required program forms (assessments, care plans, progress notes, consents) within designated timelines.</li><li>
Track and report outcomes for maternal and child health indicators (e.g., prenatal care, immunizations, developmental screenings).</li></ul>
Collaboration &amp; Advocacy<ul><li>
Coordinate services with health providers, schools, early childhood programs, and social service agencies.</li><li>
Advocate on behalf of clients to access benefits, rights, and resources.</li><li>
Participate in case conferences, multidisciplinary team meetings, and community partnerships.</li></ul>
Professional Development &amp; Supervision<ul><li>
Participate in reflective supervision, peer case review, and ongoing professional development.</li><li>
Maintain compliance with continuing education requirements for licensure.</li></ul>
Uphold program fidelity to evidence-based home visiting models.
Minimum Qualifications<ul><li>
Master&rsquo;s degree required in Social Work (MSW), Counseling, Psychology, Maternal/Child Health, Nursing, or a related human services field.</li><li>
At least 2 years of experience in case management, counseling, or direct services with pregnant women, infants, or young children.</li><li>
Knowledge of maternal and child health, infant development, trauma-informed care, and family systems.</li><li>
Strong interpersonal, communication, and crisis intervention skills.</li><li>
Ability to conduct home visits and work a flexible schedule, including occasional evenings/weekends.</li><li>
Proficiency with Microsoft Office and electronic case management systems.</li></ul>
Preferred Qualifications<ul><li>
Licensed or license-eligible in DC (e.g., LICSW, LPC, LMFT, RN).</li><li>
Bilingual skills (Spanish, Amharic, Arabic, Dari, or other languages common in DC).</li><li>
Experience with evidence-based home visiting models (NFP, PAT, HFA, EHS-HV).</li><li>
Familiarity with DC community resources, Medicaid, WIC, SNAP, and maternal/child health systems.</li></ul></div>

Case Manager, Maternal Home Visiting Program

Humana

<div><h1 class="jobSectionHeader">Become a part of our caring community and help us put health first 
</h1>
As a Senior Network Performance Professional at Humana, you will play a pivotal role in enhancing provider performance and advancing Humana's mission to deliver high-quality healthcare. You will work with providers to improve their STARs ratings and overall performance through strategic initiatives and strong relationship-building. This role offers a unique opportunity to leverage your expertise in healthcare provider relations to influence operational decisions and support the overall success of the organization. You will operate with a high degree of independence, often determining methods/approach to work and establishing own work priorities and timelines. Your work consists of tasks that are moderately complex, requiring minimal instructions to achieve solutions. You may provide coaching and/or review the work of lower-level associates. You will make decisions on moderately complex issues; exercises discretion and judgment over policies and own approach/priorities. Your work impacts the achievement of results for the department and begins to influence the department's strategy.
Key Responsibilities:<ul><li>
Provider Collaboration: Work with providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor performance toward these goals.</li><li>
Stars/Quality Program Expertise: Serve as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience. Collaborate to develop tailored action plans and communicate actionable insights to improve performance.</li><li>
Performance Improvement: Actively monitor and analyze provider performance data to identify areas for improvement. Implement strategies to enhance outcomes and provide ongoing support and guidance to providers.</li><li>
Resource Liaison: Act as a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools. Facilitate communication between providers and internal teams to ensure seamless access to necessary resources and support.</li><li>
Reward Programs: Educate provider groups on reward programs and target metrics, collaborating to achieve established goals. Monitor and report on the effectiveness of reward programs, making recommendations for enhancements as needed.</li><li>
Provider Abrasion Resolution: Resolve provider abrasion issues effectively, ensuring a positive and collaborative relationship between Humana and its providers. Implement strategies to minimize provider abrasion and enhance overall satisfaction.</li><li>
Internal Collaboration: Partner with internal teams to track and report on market performance, ensuring alignment with organizational goals. Collaborate with cross-functional teams to drive initiatives that support provider performance</li></ul><h1 class="jobSectionHeader"> 
Use your skills to make an impact 

</h1>Required Qualifications<ul><li>
Bachelor's degree in business, finance, health care/administration, nursing (BSN), or a related field, or equivalent work experience.</li><li>
Experience with Medicare Risk Adjustment and/or medical coding.</li><li>
Experience with Medicare and/or managed care.</li><li>
Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System, and CAHPS/HOS survey system.</li><li>
Ability to drive interoperability and understanding of Consumer/Patient Experience.</li><li>
Proven experience building relationships with physician groups and influencing execution of recommended strategies.</li><li>
Strong communication and presentation skills, both verbal and written, with experience presenting to internal and external customers, including high-level leadership.</li><li>
Focus on process and quality improvement, with an understanding of metrics, trends, and the ability to identify gaps in care.</li><li>
Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.</li><li>
Candidates must live in WA, MT, or UT.</li><li>
Willingness to travel a minimum of 25% within region.</li><li>
Must be able to work during 8:00 a.m. &ndash; 5:00 p.m. Monday &ndash; Friday according to Pacific (PST) or Mountain (MST) time zones.</li></ul>
Additional Information
Work At Home / Internet Statement:
To ensure Home or Hybrid Home/Office employees&rsquo; ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:<ul><li>
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.</li><li>
Satellite, cellular and microwave connection can be used only if approved by leadership.</li><li>
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.</li><li>
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.</li><li>
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.</li></ul>
SSN Alert Statement: 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&rsquo;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
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. 

$78,400 - $107,800 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, &ldquo;Humana&rdquo;) 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.<h1 class="jobSectionHeader"> 
About us 
</h1>
Humana Inc. (NYSE: HUM) is committed to putting health first &ndash; 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 &ndash; 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.</div>

Sr. Network Performance Professional

Tutor Me Education

<div>
 Tutor Me Education is reshaping how students learn. We are looking for teachers and tutors with special education experience to provide 1:1 or group instruction to students all across the country!
 
 
 
 Here Are The Details
 
 
 
 <ul>
 <li>
 Virtual instruction from your home computer, on your schedule! This is a remote job! (PST hours preferred)
 </li>
 <li>
 Set your own availability and change it at any time
 </li>
 <li>
 Set your own hourly rate and negotiate on a per job basis
 </li>
 <li>
 We will ask you to share the subjects you can teach the best, and systematically send jobs to your email based on those subjects
 
 
 </li>
 </ul>
 
 About Tutor Me Education
 
 
 
 <ul>
 <li>
 We are a tutoring and test-preparation platform that connects tutors with clients and school districts
 </li>
 <li>
 Tutors set their own hourly rate and decide which tutoring jobs to accept based on their availability
 </li>
 <li>
 At Tutor Me Education, there are always new job opportunities with hundreds of new students signing up every day!
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 Job requirements:
 
 
 <ul>
 <li>
 Previous tutoring/teaching experience highly preferred
 </li>
 <li>
 Previous experience with special education, accommodations, and working with students with learning disabilities highly preferred
 </li>
 <li>
 At least a Bachelor's degree
 </li>
 <li>
 Ability to make learning fun and interactive, with the focus of the tutoring often determined by student questions and comments
 </li>
 <li>
 Ability to pass a background check if required
 </li>
 <li>
 This is a contract job, with opportunities for additional tutoring/virtual instruction thereafter. Tutors and teachers on our platform systematically receive opportunities as they come in based on experience, subjects offered, availability, etc.
 
 
 </li>
 </ul>
 
 Benefits
 
 
 
 Flexible schedule!
 
 
 Work from home on your personal computer!
 
 
 Set your own hourly rate!
</div>

Special Education Tutor (Remote)

<div>
 
 Become a part of our caring community and help us put health first
 
 
 
 Are you a transitioning military service member or a military spouse looking for an internship that supports the goal to put health first?
 
 
 The DOW SkillBridge Internship and Military Spouse Fellowship Programs will provide you with key training to perform your internship. You will partner with your team to support members, projects, and to meet goals impacting business outcomes. The professionals you work with at Humana will depend on the type of internship you select. They may include healthcare professionals, HR, and IT, to name a few. The objective is to support and facilitate care for members.
 
 
 To be eligible for this internship, you must either be a transitioning military service member or a military spouse, and you must obtain eligibility to participate in these DOW sponsored programs.
 
 
 The Prior Authorization, Registered Nurse, RN, Intern will report to a manager of the National Medicaid team. You will utilize training and engage formerly acquired skillsets to complete medical necessity reviews for requested services using clinical judgment and provides referrals to internal stakeholders for further review depending on case findings.
 
 
 
 You will participate in the following assignments in this role:
 
 
 
 
 Clinical Review
 
 
 
 <ul>
 <li>
 Conduct comprehensive clinical reviews of prior authorization requests to determine medical necessity and benefit eligibility.
 </li>
 <li>
 Apply advanced evidence-based clinical guidelines in review decisions.
 </li>
 <li>
 Ensure compliance with accreditation, state, and federal regulations.
 
 
 </li>
 </ul>
 
 Communication And Coordination
 
 
 
 <ul>
 <li>
 Communicate with healthcare providers to obtain necessary clinical information and clarify requests.
 </li>
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 Coordinate with medical directors and interdisciplinary teams to support decision-making.
 </li>
 <li>
 Serve as a liaison between clinicians, internal departments, and members.
 
 
 </li>
 </ul>
 
 Documentation And Reporting
 
 
 
 <ul>
 <li>
 Document all review findings and decisions in clinical documentation systems.
 </li>
 <li>
 Ensure timely and accurate documentation of prior authorization determinations.
 </li>
 <li>
 Support reporting initiatives and provide data for performance improvement projects.
 
 
 </li>
 </ul>
 
 Quality Assurance
 
 
 
 <ul>
 <li>
 Implement quality assurance measures to ensure accuracy and consistency in prior authorization decisions.
 </li>
 <li>
 Conduct regular audits and reviews to maintain high standards of service.
 </li>
 <li>
 Identify process improvement opportunities and contribute to performance improvement projects.
 
 
 </li>
 </ul>
 
 Education And Training
 
 
 
 <ul>
 <li>
 Educate providers and staff on prior authorization policies, criteria, and review processes.
 </li>
 <li>
 Provide mentorship and feedback to nonclinical staff and peers to enhance workflow efficiency.
 </li>
 <li>
 Stay current with clinical best practices and regulatory changes.
 
 
 </li>
 </ul>
 
 Required Qualifications
 
 
 
 
 Use your skills to make an impact
 
 
 
 <ul>
 <li>
 You must be a transitioning service member eligible to participate in the DOW SkillBridge or a military spouse eligible to participate in the military spouse fellowship&middot;
 </li>
 <li>
 Active Registered Nurse, RN, enhanced Compact, (eNLC) license without restrictions or disciplinary action.
 </li>
 <li>
 Minimum two (2) years clinical nursing experience such as acute care, emergency room, ICU, skilled or rehabilitation setting.
 </li>
 <li>
 Working knowledge of MS Office including Word, Excel, PowerPoint, and Teams in a Windows based environment and an ability to quickly learn new systems and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
 </li>
 <li>
 Possess an interest in working in the managed care industry
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Bachelor's degree
 </li>
 <li>
 Previous Medicare/Medicaid experience.
 </li>
 <li>
 Previous experience in prior authorization, utilization management.
 </li>
 <li>
 Experience working with MCG or Interqual guidelines.
 </li>
 <li>
 Certification in Case Management, (CCM) or Utilization Review, (UR).
 </li>
 <li>
 Knowledge of payer policies, insurance companies and government health programs.
 
 
 </li>
 </ul>
 
 Workstyle:
 
 Remote Work at Home
 
 
 
 Location:
 
 Must reside in a state that participates in the enhanced compact license, (eNLC)
 
 
 
 Work Schedule:
 
 Weekdays 8:00 AM to 4:30 PM Central Time
 
 
 
 Travel:
 
 None
 
 
 
 Additional Information
 
 
 
 
 Work At Home Requirements
 
 
 
 <ul>
 <li>
 WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
 </li>
 <li>
 A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
 </li>
 <li>
 Satellite and Wireless Internet service is NOT allowed for this role.
 </li>
 <li>
 A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
 
 
 </li>
 </ul>
 
 The DOW SkillBridge Internship Program
 
 provides transitioning military service members time to gain civilian work experience while still on active duty with an employer for a period approved by their command and the DOW, with an average timeline of 90 days.
 
 
 
 The Military Spouse Fellowship Program
 
 connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities for a period up to 12 weeks.
 
 
 <ul>
 <li>
 Networking opportunities will be provided while participating in the Internship or Fellowship.
 </li>
 <li>
 Due to factors such as location, and/or requirements that cannot be modified, full-time employment is not guaranteed upon completion of the Internship or Fellowship.
 
 
 </li>
 </ul>
 
 Interview Format
 
 As part of our hiring process, we will be using a screening and interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring leaders with an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.
 
 (please be sure to check your spam or junk folders often to ensure communication isn't missed)
 
 If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
 
 
 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
 
 
 
 
 
 Scheduled Weekly Hours
 
 
 
 
 
 1
 
 
 
 About Us
 
 
 
 Humana Inc. (NYSE: HUM) is committed to putting health first &ndash; 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 &ndash; 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.
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Preauthorization Registered Nurse

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