Full-Time RN Case Manager

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.

• 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 post-discharge calls and discharge planning

• 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 RN license in the state(s) in which the nurse is required to practice
• Ability to be licensed in multiple states without restrictions
• Case Management experience
• Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
• Ability to work independently under general instructions and with a team
• Valid driver’s license and/or dependable transportation necessary (variable by region)

• Education: BSN or Bachelor’s degree in a related field
• Case Management certification (CCM)
• 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

Schedule

:  Full-time

Primary Location

:  US-OH-Cincinnati

Role

:  Clinical Innovations and Health Practitioners

Work Environment Type

:  Virtual/Work At Home

Travel

:  Yes, 10 % of the Time