Role:RN-Onsite Review Nurse - Doctor's Hospital Assignment: Medicare Location: Augusta, GA
The hours for this role are Mon-Fri, 8am-5pm est.
Humana is seeking a Onsite Nurse who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.
Work location is Onsite at the facility
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
Active RN license in NC
Ability to be licensed in multiple states without restrictions
Previous experience in Utilization Management
Experience with Interqual or Milliman
Prior clinical experience in an acute care, skilled or rehabilitation clinical setting
Ability to work independently under general instructions and with a team
This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
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 systems is10Mx1M required Role Desirables
Education: BSN or Bachelor’s degree in a related field
Health Plan experience
Previous Medicare/Medicaid Experience a plus
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will 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 in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Title: RN-Onsite Review -Doctor's Hospital Augusta, GA
Other Locations: US-GA-Augusta
Requisition ID: 178522