RN Onsite Review Nurse - Morgantown, WV at Morgantown

Job Description

Role: RN Onsite Review Nurse

Assignment: Medicare

Location: Morgantown, WV

Humanas dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humanas Perfect Service means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule

Be a part of our Clinical Space as a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.

Humana is seeking a Clinical RN Advisor who 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 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

Key Competencies

• Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of ones 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.

Job Requirements

Role Essentials

• Active RN license in WV
• Prior clinical experience in an acute care, skilled or rehabilitation clinical setting
• Ability to work independently under general instructions and with a team
• Computer proficient

Role Desirables

• Education: BSN or Bachelors degree in a related field
• Health Plan experience
• Previous Medicare/Medicaid Experience a plus
• Previous experience in utilization management

Additional Information

Humana is an organization with careers that change livesincluding yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If youre 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 whats happening at Humana.

Country: USA, State: West Virginia, City: Morgantown, Company: Humana.