Role: RN - Post Discharge / Telephonic Case Mgt
Location: Central Region (OK, MO, AR, KS)
Hours are 8:30a-5:00p CST
Humana\u2019s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana\u2019s Perfect Service\u00ae means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.
Be a part of our Clinical Space \u2013 as a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.
Humana is seeking a Clinical RN Advisor who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.
Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design
Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally
Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols
Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria
Conduct admission review, post-discharge calls and discharge planning
Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.
Accountability: Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Customer Focus: Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.
Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
Active RN license in the state(s) in which the nurse is required to practice
Ability to be licensed in multiple states without restrictions
Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Previous Case Management Experience
Ability to work independently under general instructions and with a team
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana's systems if 10Mx1M
Education: BSN or Bachelor\u2019s degree in a related field
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Previous experience in utilization management, discharge planning and/or home health or rehab
Bilingual is a plus
Humana is an organization with careers that change lives\u2014including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you\u2019re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Website : http://www.humana.com
Humana's diverse lines of business work to serve all types of consumers. From families to seniors to military members to self-employed individuals, there is a plan to meet many unique needs. Find out how Humana's associates and corporate leaders are committed to customer service. Our team uses innovation to deliver results to our consumers.