Case Management - Care Coordinator (PODS)-Louisville, KY
Humana - Louisville, KY

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Examine clinical programs information to identify members for specific Case Management/Chronic Care / or Disease Management activities or interventions by utilizing established screening criteria

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Provider education on referral management and processes

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Monitor practice's patient participation in Humana's clinical programs.

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Promote Humana's clinical programs and resources

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Facilitate member clinical program engagement

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Identifies areas to engage member clinical program participation.

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Consult with Clinical Program Case Mangers and nurses to identify member specific opportunities to address with a Provider

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Identify Chronic Complex members not participating in Humana Cares and refer PODS members to program

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Expertise on Clinical Programs available to PODS members, and ability to analyze available data to identify members who can benefit from available programs.

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Consult with PODS owner on Clinical Program opportunities needing addressed in a Provider visit

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Review member specific and provider specific data to identify concerns needing follow up by assigned Case Managers

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Identify medication usage opportunities needing Pharmacy Consultant involvement.

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Coordination of Clinical Program specific representation or input in to PODS Owner or Strategy Meetings

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

Strong analytical skills

Ability to be licensed in multiple states without restrictions

Prior clinical experience preferably office practice or hospital setting

Ability to work independently under general instructions and with a team

Organizational and prioritization skills

Ability to collaborate with multiple departments

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

Role Desirables

Education: BSN or Bachelors degree in a related field

CMS Stars/performance measures/HEDIS knowledge and experience

Understanding of clinical programs

Provider and member rewards program knowledge

Coding knowledge

Previous experience in case or disease management and utilization management

Experience in a state and/or federally regulated health care environment

Excellent PC skills specifically Excel and powerpoint

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.

Schedule

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Full-time

Primary Location

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US-KY-Louisville

Role

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Service Operations

Work Environment Type

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Office

Travel

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Yes, 10 % of the Time

Humana - 23 months ago - save job - copy to clipboard
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Humana Inc. (Humana) is a full-service benefits solutions company, offering an array of health and supplemental benefit plans for employer...