Humana is looking for a Medical RN Advisor who will collaborate with different well being care givers in reviewing precise and proposed medical care and providers towards established CMS Protection Tips evaluation standards.
Handle community participation, care with specialty networks, care with DME suppliers and transfers to various ranges of care utilizing your information of profit plan design
Advocate providers for Humana Plan members using care options out there inside the group and nationally
Determine probably pointless providers and care supply settings, and advocate options if applicable by analyzing medical protocols
Look at medical packages info to determine members for particular case management and / or illness management actions or interventions by using established screening standards
Conduct admission evaluate, submit-discharge calls and discharge planning
Key Competencies
Builds Belief
: Persistently fashions and evokes excessive ranges of integrity, lives as much as commitments, and takes duty for the impression of 1’s actions.
Accountability
: Meets established expectations and takes duty for attaining outcomes; encourages others to do the identical.
Buyer Focus
: Connects meaningfully with clients to construct emotional engagement and buyer advocacy. Simplifies complexity and integrates inner efforts to ship an optimum buyer expertise.
Executes for Outcomes:
Successfully leverages assets to create distinctive outcomes, embraces change, and constructively resolves obstacles and constraints.
Qualifications
Position Necessities
Lively RN license within the state of Florida
Potential to be licensed in a number of states with out restrictions
Prior medical expertise ideally in an acute care
Capability to work independently beneath common directions and with a staff
Earlier expertise in utilization management, case management, discharge planning and/or chart critiques and audits
TB check required if employed
Position Desirables
Schooling: BSN or Bachelor’s diploma in a associated area
Well being Plan expertise
Earlier Medicare/Medicaid Expertise a plus
Name middle or triage expertise
Bilingual is a plus
Further Info
Humana is a corporation with careers that change lives—together with yours. As an innovator within the quick-paced business of healthcare, we provide our associates careers that problem, help and encourage them to make use of their ardour for serving to others and to steer their greatest lives. Should you’re prepared to assist individuals obtain lifelong nicely-being, and be part of a corporation that’s rising and poised to make an influence on the way forward for healthcare, Humana has the appropriate alternative for you.
Schedule
:
Full-time
Main Location
:
US-FL-Gainesville
Position
:
Medical Improvements and Well being Practitioners
Work Setting Sort
:
Digital/Work At House
Journey
:
Sure, 75 % of the Time
Source: https://www.businessnetworkingorangecounty.com/utilization-management-onsite-nurse-gainesville-fl-humana-gainesville-fl/
No comments:
Post a Comment