Acute Utilization Management Telephonic Nurse - North Central Region
Location: Omaha, Nebraska
Description: Humana is at present recruited Acute Utilization Management Telephonic Nurse - North Central Region right now, this vacancy will be reside in Nebraska. Further informations about this vacancy opportunity kindly see the descriptions. Be a part of our Clinical Space â€" as a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.
Humana is seeking a Clinical 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
- Active RN license in the state(s) in which the nurse is required to practice
- 3-5 years of Med Surg, Heart, Lung or Critical Care Nursing experience required
- Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Must have good typing skills and proficiency using MS Office Word, Outlook and Excel
- Ability to work independently under general instructions and with a team
- Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
- 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
Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Humana is an organization with careers that change livesâ€"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.
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.
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If you were eligible to this vacancy, please send us your resume, with salary requirements and a resume to Humana.
Interested on this vacancy, just click on the Apply button, you will be redirected to the official website
Apply Acute Utilization Management Telephonic Nurse - North Central Region Here
This vacancy will be opened on: Thu, 04 Jan 2018 09:13:05 GMT