Nurse Case Manager
Humana (Miami, Florida)

This job posting has expired.

You may wish to try a search for Nurse Case Manager

Or visit the FlipDog home page
 

Job Description: 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.

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies, with approximately 11.3 million medical members located primarily in 15 states and Puerto Rico. 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. Over its 46-year history, Humana has consistently seized opportunities to meet changing customer needs. Role:Clinical Innovations / Clinical Advisor LPN Assignment: Case Manager Location: South Florida: On-site Float position for the tri-county area (Miami-Dade, Broward, Palm Beach)for hsopitals and SNF's Are you a fit? Do you have a desire to be in a position where you can 'provide guidance to our members related to their health care needs? Assignment Capsule As a Clinical Advisor you will collaborate with other health care givers in reviewing actual and proposed medical care and services against established clinical review criteria. Coordinate network participation, specialty networks, Disease Management providers and patient transfers to alternative levels of care using your knowledge of benefit plan design Conduct admission reviews Perform Post-discharge calls Facilitate in discharge planning Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally Identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria (Variable by region) 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 Current License Practical Nurse (LPN) in the state in which the nurse will be required to practice Ability to be licensed in multiple states without restrictions Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting Ability to work independently under general instructions and with a team Role Desirables Health Plan experience Medicare / Medicaid experience Call center or triage experience May substitute equivalent education and/or experience for degree Previous experience in utilization management, discharge planning and/or home health or rehab Bilingual is a plus Reporting Relationships You will report to a director. This area is under the leadership of the SVP & Chief Operating Officer. Additional Information This position is for an on-site FCM float for the tri-county area. This person needs Utilization/CM experience...field review a plus. Needs to be willing and able to drive tri-county. Knowledge of managed care, coding and DRG management. Assertive personality to be able to deal with facilities, vendors, and MD's.

Minimum Education Required: Bachelor Years of Experience Required: 3-5 Years Expected Travel Time: None