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The Care Manager will advocate and guide utilizing motivational interviewing techniques and intervene on behalf of their members to ensure successful completion of member goals, while providing Complex Case Management and/or care management support through the duration of the care plan. The Care Manager supports the implementation of the Value Based Care Management program in an appropriate and efficient manner by providing high-quality telephonic Case or Care Management with CareFirst members.

YEAR

Job Description: Job Summary: Start Date:Monday October 27, 2025 Salary:$85,000 annually, plus comprehensive benefits package The Care Manager supports the implementation of the Value Based Care Management program in an appropriate and efficient manner by providing high-quality telephonic Case or Care Management with CareFirst members. The Care Manager partners with members, caregivers, providers, and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to improved health outcomes. The Care Manager will advocate and guide utilizing motivational interviewing techniques and intervene on behalf of their members to ensure successful completion of member goals, while providing Complex Case Management and/or care management support through the duration of the care plan. Essential Job Functions: + Engage telephonically with members, caregivers, and providers to develop a comprehensive plan of care, identify key strategic interventions, and address the members needs at various stages along the care continuum. + Serve as an extension of the care team by collaborating with PCPs, specialists, other clinicians, and member to meet health care goals through development and implementation of Care Plans. + Assess the member’s ongoing care needs and progress towards goals throughout the plan duration and make revisions as needed to address changes in the member’s condition, lack of progress toward goals of the care plan, preference changes, and transitions in care settings. Coordinates plan of care with goals of member stabilization, decreased admissions, medication management, behavior change and ability to self-manage. + Coordinate patient education in support of standards of care guidelines and related health issues using the most appropriate modality for the member. + Identify relevant benefit and community resources, evaluates Social determinants of Health and facilitates referrals based on member need. + Assist the member in coordination of any additional tests, images and consults with specialists. + Perform medication reconciliation at the onset of care plan, after changes in health status, and every thirty days during the life cycle of the care plan, assessing for efficacy and drug interactions/side effects. + Facilitate and monitor the transition of care which involves moving the member from one healthcare practitioner to another as their healthcare needs change. Implements and oversees the agreed upon plan of care as well as coordinates member follow-up post discharge. + Utilize established documentation standards to maintain quality of care plan documentation to include member progress toward their established state of being and barriers to achievement of care plan objectives and outcomes. + Abide by Value Based Care Management Program Description and Guidelines. + Meet productivity and quality metrics as outlined by leadership for each year. + Complete mandatory training and annual competency testing. + Actively participate in team huddles and contribute to clinical learning. + Remain current on clinical knowledge via self-directed learning. Specific Skills/ Attributes: + Strong motivational interviewing and case management skills. + Ability to be self-directed, highly organized, multi-task capable, and proficient in problem solving skills. + Ability to meet established deadlines. + Exceptional oral, written, and presentation skills. + Ability to effectively communicate and provide positive customer service to internal and external customers, meeting the expectations for service excellence. + Successfully partner with all levels of administrative and professional personnel. + Demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads. + Success with engaging members. Outstanding customer service skills and ability to adapt approach to various personalities. + Ability to extrapolate information from a variety of sources including medical records to create concise records that accurately depict the medical “story” of the member. + Proficiency with data analysis and ability to organize data in support of reporting needs. + Ability to proactively identify and assimilate quality improvement processes into practice. + Experience with medically oriented care plan documentation. + Experience working effectively within a matrix organizational design. Qualifications: + Current multi-state compact Registered Nurse licensure in state of residence is required, with ability to obtain additional licenses without restriction. BSN preferred. + Training in motivational interviewing preferred. + Minimum 3-5 years varied clinical experience with telephonic Case Management experience strongly preferred. + Demonstrates computer competencies to include electronic medical records, word processing, spreadsheet, presentation preparation, and. Demonstrated ability to learn customized computer applications. + Maximize all technology inclusive of Microsoft Teams, Microsoft Word, Microsoft Excel, Microsoft Outlook, laptop computers, and all other relevant unified communication technologies. + This position will be based from a home office which must satisfy all HIPAA requirements and minimum internet connectivity requirements. + Ability to communicate with members, other members of the team, physicians, and plan representatives. + Ability to read, analyze, and interpret common scientific and technical journals. Ability to effectively present information to audiences with a variety of knowledge/skill levels _Note:_ _The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs._ Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law. Sharecare is an Equal Opportunity Employer and doesn't discriminate on the basis of race, color, sex, national origin, sexual orientation, gender identity, religion, age, disability, genetic information, protected veteran status,or other non-merit factor.

Sharecare

Care Manager, Registered Nurse- Remote

Sharecare, Inc.

The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Through our Humana insurance services, and our 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.

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact Use your skills to make an impact Required Qualifications + ​Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action. + MUST have Compact License + Greater than one year of clinical experience in a RN role in acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc. + Comprehensive knowledge of Microsoft Word, Outlook and Excel + Ability to work independently under general instructions and with a team + Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications + Education: BSN or Bachelor's degree in a related field + Three or more years of clinical experience in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc. + Experience as an MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/utilization review for a health plan or acute care setting + Compact license PLUS a single state RN Licensure in any of the following non-compact states: California, Hawaii, Nevada, Oregon + Health Plan experience + Previous Medicare/Medicaid Experience a plus + Call center or triage experience + Bilingual is a plus Additional Information + Scheduled Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Work-At-Home Requirements + Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). + A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required. + Check your internet speed at www.speedtest.net + A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information. 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 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 About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family. About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Humana

SNF Utilization Management RN - Compact Rqd

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