Case Manager Post Discharge Nurse - Medicare

Apply by eMail:15348848.185@jobfrenzy1.com

Description:
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: RN - Post Discharge / Case Management
Assignment: Case Manager Post Discharge Nurse - Medicare
Location: Phoenix, AZ

Are you a fit?

Do you enjoy working with the Medicare population? Do you have a desire to be in a position where you can 'provide guidance to our Medicare population related to their health care needs?

Assignment Capsule
You will work with identified members to assess their care needs immediately post discharge. You will assist in planning and implementing interventions to meet those needs, assist in coordinating services, and monitor and evaluate the case management plan against the member's personal health care goals. You 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 using care alternatives available within the community and nationally
Examine clinical programs information to: manage our members on an outpatient basis and develop strategies to prevent readmission; mine health risk assessment data reports to identify potentially high-risk membership; identify and refer members to Disease Management Programs; conduct discharge planning; coordinate Behavioral Health management
Coordinate: in versus out-of-network movement; care in out-of-network facilities; care with specialty networks; care with DME providers; transfers to SNF and back
Conduct post-discharge calls and discharge planning.

Competencies
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.

Role Essentials
Current RN license in the state in which the nurse will be required to practice
Ability to be licensed in multiple states without restrictions
2-5 years 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

Role Desirables
Education: BSN or Bachelors degree in a related field preferred
Special Certifications: Case Management Certification preferred
Health Plan experience preferred
Previous Case Management experience
Medicaid/Medicare experience preferred
Bilingual is a plus

Reporting Relationships
You will report to a Manager or Supervisor. This area is under the leadership of the Health Services Director.

Additional Information
This is an in office position.
The work hours are from 8am - 5pm Monday through Friday.

Requirements:
See Above

Education: Not Specified

Experience: More than 5 years

Travel: About 25%

Apply by eMail:15348848.185@jobfrenzy1.com

Job Created: Fri Oct 30 2009 04:27:33 AM
Last Modified: Fri Oct 30 2009 04:27:33 AM