Location: San Antonio, TX
Employment Type: Full Time
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?
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.
Job Code: 46200
Category: Health Care
Post Date: Monday, August 29, 2011 at 5:01 AM
Contact Name: http://www.humana.com/careers
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