Humana RN or LPN - Clinical Care Coordinator - Quality - Overland Park, KS in Overland Park, Kansas

Role:Clinical Care Coordinator

Assignment: Senior Products/Quality Initiative

Location: Overland Park, KS

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

Assignment Capsule

Be a part of our Clinical Team – as a Clinical Care Consultant you will drive the engagement of members for specific Case Management/Chronic Care / or Disease Management activities or interventions by utilizing established screening criteria and ensure communication and action:

· Identify opportunities for improving the well-being of chronic members by monitoring program referrals · Identify provider opportunities in the pre-contract phase and coordinate data across functional areas to manage post contract expectations · Craft Member Profiles for use in collaboration with team members (i.e. internal and external stakeholders) in order to improve member well-being · Research cost and utilization outliers, drilling down into metrics such as % of Annual Wellness Visits, admission metrics, and emergent and urgent care metrics · Other duties as assigned

Role Essentials

  • Active LPN or RN license

  • Education: Certificate or degree from an accredited school of Nursing

  • Ability to be licensed in multiple states without restrictions

  • Prior clinical experience and expertise preferably in an acute care or provider setting practice

  • Ability to work with a team

  • Strong analytical skills, able to research, manipulate and interpret data

  • Ability to demonstrate problem solving skills

  • Office practice/ hospital experience

  • Organizational and prioritization skills

  • Valid driver’s license and dependable transportation necessary
    Role Desirables

  • Education: Bachelor's Degree

  • Health Plan experience

  • Previous Medicare/Medicaid Experience a plus

  • Knowledge and experience working with nationally established clinical quality guidelines and measurement sets such as HEDIS/NCQA or Joint Commission Standards for Accreditation

  • Call center or triage experience

  • Utilization management knowledge and experience

  • Provider and member rewards program knowledge and experience

  • Experience in a state and/or federally regulated health care environment

  • Understanding of clinical programs
    Reporting Relationships
    You will report to a Clinical Strategic Consultant. This area is under the leadership of the SVP & Chief Operating Officer.

Title: RN or LPN - Clinical Care Coordinator - Quality - Overland Park, KS

Location: Kansas-Overland Park

Requisition ID: 177003