Humana Onsite Nurse Liaison - Medicare - Jackson, MS in Ridgeland, Mississippi

Role: RN Utilization Review Nurse - Onsite Liaison


Location: Jackson,MS

Assignment Capsule

You 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 Mississippi
  • Ability to be licensed in multiple states without restrictions
  • Minimum 3 years clinical experience in an acute care, skilled or rehabilitation clinical setting
  • Ability to work independently under general instructions and with a team

  • To be considered for work at home after 6 months, you must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10Mx1M

  • Must be ok to travel to onsite facilities in Jackson, MS area

  • TB test required if hired for role

Role Desirables

  • BSN
  • Utilization Review experience in a managed care, home health or hospital setting
  • Health Plan experience
  • Previous Medicare/Medicaid Experience a plus

Reporting Relationships

You will report to a Frontline Leader. This area is under the leadership of the SVP & Chief Operating Officer.

Title: Onsite Nurse Liaison - Medicare - Jackson, MS

Location: Mississippi-Ridgeland

Requisition ID: 192285

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.