Clinical Advisor-RN – Phoenix

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.

Role: Clinical Innovations / Clinical Advisor, RN
Assignment: Case Manager, RN
Location: Phoenix, AZ

Are you a fit?
Do you enjoy working with medical members? Do you have a desire to be in a position where you can 'provide guidance to our member population as it is related to their health care needs? If so then read on!
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

Key Competencies

• Leveraging Technology: You are technological 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

• 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
  
• Valid drivers license and/or dependable transportation necessary (variable by region))

Role Desirables

• Education: BSN or Bachelors 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

Reporting Relationships
You will report to a Manager or Supervisor.

Additional Information

CLINICAL ADVISOR - RN - Senior Segment
Phoenix, AZ



Are you a compassionate, self-directed, organized and driven Registered Nurse? If you answered yes, we want to talk to you!


JOB SUMMARY:
Humana Clinical Advisors enjoy many successes, including: working with Senior members to assess their care needs, and assisting in planning and implementation of interventions to meet those needs. Assists in coordinating services, monitoring, and evaluating case management plans against the members personal health care goals. Is able to utilize knowledge of benefit plan design and care alternatives available within the community and nationally in order to recommend services. Processes authorizations, assists with discharge planning and makes referrals to Case/Disease Management programs. Supports all Utilization Management functions to en

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