Clinical Advisor-RN – Tulsa

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies, with approximately 11 million medical members located primarily in 15 states and Puerto Rico. 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.

Over its 46-year history, Humana has consistently seized opportunities to meet changing customer needs.

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: Clinical Innovations / Clinical Advisor, RN
Assignment: Health Services Utilization Management/Discharge Planner
Location: Tulsa, OK

Are you a fit?
Do you enjoy working with medical members? Do you have a desire to be in a position where you can 'provide guidance to our member population as it is related to their health care needs? If so then read on!
Assignment Capsule
Humana's Health Services UM/Discharge Planners are charged with supporting Medicare plan members located in the cities as noted above in assessing their needs, assisting in coordination of interventions and services to meet those needs and communication with members, providers and Humana associates to promote efficient use of the continuum of care. The Health Services UM/Discharge Planner utilizes knowledge of benefit plan design and care alternatives available within the community and nationally in order to recommend services that represent the delivery of appropriate health care services for Humana Plan members as ordered by the member's care provider.

Key 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.

• Active RN license in the state(s) in which the nurse is required to practice
  
• Ability to be licensed in multiple states without restrictions
  
• 7-10 years of prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
  
• Previous experience in case management, utilization management, discharge planning, home health care and/or rehabilitation
  
• Demonstrates strong communication skills that assist the applicant in working directly with members, families, and providers
  
• Ability to operate a personal computer and standard software programs
  
• 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
    
  • Health Plan/Insurance experience
    
  • Previous Medicare/Medicaid Experience a plus
    
  • Call center or triage experience
    
  • Psyche experience a plus
  
  
• Psyche experience a plus
  
  Reporting Relationships
  You will be assigned to a Local office and will report to Humana Health Services Department located in the Regional office in Overland Park, Kansas, reporting to a Manager or Director.
  This area is under the leadership of the SVP & Chief Operating Officer.
  
  Additional Information
  
• This position is a combination role of on-site and office based telephonic UM/Discharge Planning.
  
• This position is a 40 hour per week, Full-Time Position.
  Local and Regional Travel is required 80% of the time. Regional Participation in the On-Call Program is required.
  Ability to travel to another Humana Market Office for training.
  
  Apply Here