RN - Telephonic Case Management - Medicare - Central Region (OK, MO, KS, AR)
Location: Tulsa, Oklahoma
Description: Humana is presently looking of RN - Telephonic Case Management - Medicare - Central Region (OK, MO, KS, AR) right now, this occupation will be arranged in Oklahoma. For complete informations about this occupation opportunity kindly see the descriptions.
Be a part of our Clinical Space â€" as a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.
< div>Humana is seeking a Clinical RN Advisor who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.
- 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
Role Essentials
- Active RN license in the state(s) in which the nurse is required to practice
- Ability to be licensed in multiple states without restrictions
- Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Ability to work independently under general instructions and with a team
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana At Home's systems if 10Mx1M.
- Hours for this position is Monday-Friday 8:30am-5pm CST
Role Desirables
- Education: BSN or Bachelor’s degree in a related field
- Health Plan experience
- Previous Medicare/Medicaid Experience a plus
- Previous Case Management experience
- CCM preferred
- Bilingual is a plus
Additional Inform ation
Humana is an organization with careers that change livesâ€"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.
Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people ac ross the nation with whom the company has relationships.
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