Role: Clinical Guidance Specialist Assignment: Care Plus Location: Doral, FL
Humana’s 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’s Perfect Service® 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.
Assignment Capsule Be a part of our Clinical Space- Provide guidance to facilitate interaction or services that connect people with lifelong well-being. As a Clinical Guidance Specialist you will contribute to the success of Humana’s business strategy by collecting broad based information and gathering resources and data in order to arm the team with the tools necessary to enhance consumer engagement, choice, and trust. * Make outbound calls to providers to obtain and confirm clinical information
Process pre-service determination (referral requests)
Ensure complete and accurate documentation related to all pre-service determination requirements
High School Diploma or equivalent
Prior healthcare experience in hospital, physician office and/or health plan
Knowledge of medical terminology
Excellent communication skills, both verbal and written
Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
Intermediate in Microsoft Office Word and Excel
Good interpersonal skills Role Desirables
Associate’s or Bachelor’s Degree in Business, Finance or a related field
Previous managed care experience
Bi-lingual - English/Spanish
Familiar with ICD-10 and CPT codes
Previous experience in a call center setting and production environment Reporting Relationships You will report to a Front Line Leader.
Additional Information Humana is an organization with careers that change lives—including 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’re 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.
/ Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. / / / Interview Format 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.
Please be advised, the role opportunity displayed here is for CarePlus - a wholly owned subsidiary of Humana Inc.
Title: Clinical Guidance Specialist
Requisition ID: 177349