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.
Role: Clinical Advisor RN
Assignment: Health Guidance Organization
Location: Minnetonka, MN
Are you a fit?
Do you have a desire to be in a position where you can use your clinical experience and knowledge with the goal of improving the health of Humana members and HEDIS improvement? If so, then read on!
As a Clinical Advisor RN you will collaborate with other Humana departments and our network providers as it relates to Quality of care concerns as well as participate in activities associated with HEDIS, CAHPS, HOS, Commercial, CMS, NCQA and any other compliance requirements for the Health Plan.
Other responsibilities include:
Address any quality of care concerns for our members in the assigned territory.
Recommend actions for Humana Plan providers which would have a positive effect on their HEDIS and CAHPS and HOS scores.
Identify and recommend alternatives, if appropriate, for our providers as they deliver care to Humana members.
Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions.
Conduct clinical studies when appropriate, to identify trends of care.
Become known as a positive representative as well as a resource for our providers and when appropriate, our members for Humana Health Plans.
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.
Active unrestricted Registered Nurse (RN) license in the state of Minnesota.
Ability to be licensed as a Registered Nurse in multiple states without restrictions.
Minimal 3+ years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
Ability to work independently under general instructions and with a team.
Basic Computer skills and knowledge of Microsoft Word, Excel, Access.
Valid driver’s license and dependable transportation.
Bachelor’s degree in Nursing (BSN) or Bachelors degree in a related field.
Previous Managed Care or Health plan experience.
Knowledge of HEDIS specifications and medical records review.
Previous Medicare/Medicaid Experience.
Previous experience in quality or utilization management.
You will report to the Market Manager of Quality/Accreditation. This area is under the leadership of the Regional Quality Director.
Humana Inc. (Humana) is a full-service benefits solutions company, offering an array of health and supplemental benefit plans for employer...