Onsite Utilization Review Nurse (RN) - Twin Cities area (Minneapolis/St Paul, MN)
Location: Minnetonka Minnesota
Description: Humana is currently interviewing Onsite Utilization Review Nurse (RN) - Twin Cities area (Minneapolis/St Paul, MN) right now, this vacancy will be placed in Minnesota. More complete informations about this vacancy opportunity please read the description below. Be a part of our Clinical Space â€" as a Clinical Advisor you will engage o! ur members to develop lifelong wellbeing and health.
Humana is seeking an Onsite Utilization Review Nurse (RN) who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria. This is a work at home opportunity, but you will spend the majority of your day in the field at either acute or sub-acute care facilities doing Utilization Review.
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 sp! ecific case management and / or disease management activities ! or interventions by utilizing established screening criteria
Conduct admission review, post-discharge calls and discharge planning
Key Competencies
Builds Trust
: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.
Accountability
: Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Customer Focus
: Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.
Executes for Results:
Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
Qualifications
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
Valid drivers license and/or dependable transportation necessary (variable by region)
Role Desirables
Education: BSN or Bachelor’s degree in a related field
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
Additional Information
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 insp! ire 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.
Apply now, or join our Talent Network so you can stay informed and up to date on what’s happening at Humana.
Schedule
:
Full-time
Primary Location
:
US-Minnesota-Minnetonka
Role
:
Clinical Innovations and Health Practitioners
Work Environment Type
:
Virtual/Work At Home
Travel
:
Yes, 75 % of the Time
- .
If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Humana.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Wed, 30 Oct 2013 03:40:44 GMT
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