Be a part of our Clinical Space – as a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.
Humana is seeking a Dedicated Case Manager who will work onsite supporting providers in the Knoxville area. As a Case Manager you collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria. This role requires travel in the Knoxville area.
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
: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.
: Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
: Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.
Executes for Results:
Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
Active RN license in the state(s) in which the nurse is required to practice
Ability to be licensed in multiple states without restrictions
Minimum 5 years clinical experience in an acute care, skilled or rehabilitation clinical setting
Case Management experience
Ability to work independently under general instructions and with a team
Valid drivers license and/or dependable transportation necessary (variable by region)
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Education: BSN or Bachelor’s degree in a related field
Managed care experience
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
Humana is an organization with careers that change lives—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.
Apply now, or join our Talent Network so you can stay informed and up to date on what’s happening at Humana.
Clinical Innovations and Health Practitioners
Work Environment Type
Virtual/Work At Home
Yes, 20 % of the Time
Humana Inc. (Humana) is a full-service benefits solutions company, offering an array of health and supplemental benefit plans for employer...