Humana RN Frontline Leader - Referral Reviews in Miami, Florida

Role:RN Frontline Leader

Assignment:Care Delivery

Location: Miami, FL

Are you a fit?

Do you have a desire to be in a position where you can empower a team of associates who will provide guidance to our members regarding their health care needs?

Assignment Capsule

As a Clinical Guidance Frontline Leader you will hire, lead and develop clinical and non- clinical professional associates. Collaborate with other health care givers in reviewing actual and proposed medical care and services against established Guidelines.

· Report trends

· Develop system-view recommendations

· Implement appropriate actions to control trend

· Create and conducts provider outreach initiatives

· Ensure compliance with regulatory requirements

· Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally

· Recommend alternatives if appropriate using your knowledge of clinical protocols

· Identify members for specific case management and / or disease management activities

· Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions

Key Competencies

Leveraging Technology: You are technologically savvy and know how to appropriately share and use your knowledge to improve business results.

Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

Is Accountable: You meet clearly stated expectations and take responsibility for achieving results.

Clinical Knowledge: You understand clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications of such programs.

Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.

Role Essentials

· Current RN license in the state in which the nurse is / will be required to practice Ability to be licensed in multiple states without restrictions

· Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting

· Previous experience in utilization management, discharge planning and/or home health or rehab

· Prior supervisory experience

· Ability to work independently under general instructions and with a team

· Valid driver’s license and/or dependable transportation necessary

Role Desirables

· BSN or Bachelor’s degree in a related field

· Health Plan experience

· Prior Medicare / Medicaid experience

· Call center or triage experience

· May substitute equivalent education and/or experience for degree

· Bilingual is a plus

Additional Information

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 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 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 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 Frontline Leader - Referral Reviews

Location: FL-Miami

Requisition ID: 177875