RN, Field Case Manager, Medicaid Western Kentucky Region, Kentucky


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.

Location Requirement

This role requires residence in the Western Kentucky Region.
Must reside within the following Counties: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Livingston, Marshall, McCracken, and Trigg


Collaborate with members of an inter-disciplinary team to meet the needs of the individual and the population
Identify problems or opportunities that would benefit from care coordination
Engage the member and complete a health and psychosocial assessment, taking into account the cultural and linguistic needs of each member
Engage with the member in a variety of settings to establish an effective, professional relationship. Settings for engagement include but are not limited to; hospital, provider office, community agency, member s home, telephonic or electronic communication
Identify and prioritize the individual s care management needs and goals in collaboration with the member and caregivers
Identify and manage barriers to achievement of care plan goals
Identify and implement effective interventions based on clinical standards and best practices
Maximize the client s health, wellness, safety, adaptation, and self-care through effective care coordination and case management
Educate the member and other stakeholders about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made
Employ ongoing assessment and documentation to evaluate the member s response to the plan of care
Evaluate client satisfaction through open communication and monitoring of concerns or issues
Collaborate with facility based case managers and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner
Appropriately terminate care coordination services based upon established case closure guidelines
Provide clinical oversight and direction to unlicensed team members as appropriate
Document care coordination activities and member response in a timely manner according to standards of practice and policies regarding professional documentation
Looks for ways to improve the process to make the members experience easier and shares with leadership to make it a standard, repeatable process
Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program

Required Qualifications

Registered Nurse Licensed in the State of Kentucky without restrictions.
Three to five (3-5) years varied experience in nursing/healthcare fields (discharge planning, case management, care coordination, and/or home/community health experience)
Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
Collaborate with team members to optimize outcomes for members
Strong advocate for members at all levels of care
Strong understanding and respect of all cultures and demographic diversity
Proven track record of demonstrating empathy and compassion for individuals
Exceptional communication and interpersonal skills with the ability to quickly build rapport
Ability to work with minimal supervision within the role and scope
Ability to use a variety of electronic information applications/software programs including electronic medical records

Additional Requirements/Adherence:

Work Style:

Combination remote work at home and onsite member field visits


Must reside in or within a 50 mile radius of the following Western Kentucky counties: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Livingston, Marshall, McCracken, and Trigg


Monday through Friday 8:00 AM to 6:00 PM Eastern Time


Must be willing to travel 25% to meet with members.

Humana’s Driver Safety Program:

This role is a part of Humana’s Driver Safety program and therefore requires and individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits
Valid driver’s license, car insurance, and access to an automobile

TB Screening:

This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Work at Home Requirement Internet and Home Office

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.
A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

Bachelor s of Science in Nursing (BSN) preferred
Five (5) years or more clinical experience is preferred
Three (3) years or more Medicaid and/or Medicare managed care experience is preferred
Certification in Case Management
Bilingual English and Spanish – Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages.

Additional Information:

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn t missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Covid Vaccination Processes:

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Job Type: Full-time


8 hour shift


RN in the state of Kentucky without restrictions (Preferred)

Work Location: Multiple Locations


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