- Location: Oak Brook, IL
Job Description
Humana is seeking a Clinical RN Advisor in Oak Brook, IL who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria. As a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.
Job Responsibilities
- 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
Benefits
Humana provides tools and resources to help you make health and wellness decisions that work for you and your family.
- Medical benefits/ Dental benefits
- Healthcare spending account
- Long-term care
- Life insurance
- 401(k) Savings Plan
- Retirement Plan
- Vacation/ Paid Holidays
- Tuition Reimbursement
Job Requirements
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 driver’s 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
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