Post Discharge RN
Location: Sandy Utah
Description: Humana is currently interviewing Post Discharge RN right now, this position will be placed in Utah. Further informations about this position opportunity please read the description below. This is a telephonic work at home position making outbound calls to our members who have had recent stays in facilities. You will be doing phone assessments for post discharge needs. You will also 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.
Qualifications
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
Excellent communication skills both verbal and written
Ability to listen effectively
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. This area is under the leadership of the SVP & Chief Operating Officer.
Additional Information
Schedule
:
Full-time
Primary Location
:
US-Utah-Sandy
Role
:
Clinical Innovations and Health Practitioners
Work Environment Type
:
Virtual/Work At Home
Travel
:
No
- .
If you were eligible to this position, please email us your resume, with salary requirements and a resume to Humana.
If you interested on this position just click on the Apply button, you will be redirected to the official website
This position starts available on: Tue, 07 Aug 2012 21:26:44 GMT
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