Role: * Utilization Review/Case Manager RN *Assignment: Location: Tampa, 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 telephonically. 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 As a Neonatal Utilization Review and Case Management RN you will engage our members to develop lifelong well-being and health.
Humana Medicaid is seeking Utilization Review/Case Management nurse who will telephonically assess, plan, implement and coordinate all case management activities for our members. You will educate members and their caregivers on making choices to assist them to achieve better overall health.
Work with identified members telephonically to assess their care needs.
Assist in planning and implementing interventions to meet those needs.
Assist in coordinating services, and monitoring and evaluating the case management plan against the member's and caregiver’s personal goals during their hospital course and after discharge
Educate caregivers to member’s developmental goals, healthcare needs, well child visits and immunizations for the first year after discharge from the NICU.
Active RN license in the state of Florida
Ability to be licensed in multiple states without restrictions
Previous experience in utilization management, discharge planning and/or home health or rehab
2 years Neonatal experience
Ability to work independently under general instructions and with a team
Health Plan Experience
Previous NICU, Mother/Baby, or Labor and Delivery experience.
Prior experience with Medicare & Medicaid recipients.
Prior case management experience.
Previous experience with electronic case note documentation and experience with documenting in multiple computer applications/systems.
Experience with health promotion, coaching and wellness.
Call center or triage experience
Previous Managed Care, Case Management, or Referrals processing experience.
Knowledge of community health and social service agencies and additional community resources.
Bilingual is a plus.
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.
Title: Utilization Review/Case Manager - Neonatal NICU - RN
Requisition ID: 179097