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.

Role: Frontline Leader
Assignment: Clinical Guidance Organization
Location: San Antonio, TX

Are you a fit?
Do you have a desire to be in a position where you can empower a team of associates who will provide guidance to our members regarding their health care needs?

Assignment Capsule
As a clinical innovations front line leader you will hire, lead and develop clinical and non- clinical professional associates. Collaborate with other health care givers in reviewing actual and proposed medical care and services against established Guidelines.

• Report trends
  
• Develop system-view recommendations
  
• Implement appropriate actions to control trend
  
• Create and conducts provider outreach initiatives
  
• Ensure compliance with regulatory requirements
  
• Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally
  
• Recommend alternatives if appropriate using your knowledge of clinical protocols
  
• Identify members for specific case management and / or disease management activities
  
• Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions

• 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.

• Current RN license in the state in which the nurse is / 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
  
• Prior supervisory experience
  
• Ability to work independently under general instructions and with a team
  
• Valid drivers license and/or dependable transportation necessary

• BSN or Bachelors degree in a related field
  
• Health Plan experience
  
• Prior 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

• You will have 15-25 direct reports, and you will report to a director. This area is under the leadership of the SVP & Chief Operating Officer.