Role:Clinical Advisor, RN Assignment:Utilization Management RN Location:Phoenix, AZ or Denver, CO
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 – 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
Role Essentials * 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 * Ability to work independently under general instructions and with a team * Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test Role Desirables * Education: BSN or Bachelor’s 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 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.
The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.
Title: Utilization Management Nurse
Other Locations: US-Colorado-Centennial, US-AZ-Tucson
Requisition ID: 181225
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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.