Clinical Advisor - Utilization Review

Job Description: Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly traded health benefits companies, with approximately 9 million medical members. 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 45-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.


ASSIGNMENT SUMMARY
RN - Clinical Advisor for Utilization Review
Full Time
Location: Green Bay



Assignment Summary:

The Clinical Advisor will offer guidance services for the Commercial side of business, focusing on providing timely utilization review determinations. Promotes delivery of the right care, in the right place, at the right time. Implements high quality, cost - effective, and appropriate alternatives of care in a coordinated effort with the patient, patient's family, physicians, and other health care providers. Documents potential quality of care issues and refers them to the appropriate party.


Skills:

Strong knowledge base of health care delivery systems and benefit plans

Demonstrate a high level of experience with PC based and online computer applications

Possess excellent verbal and written communication skills;

Strong customer service skills

Possess strong analytical and problem solving abilities

Strong demonstrated interpersonal skills, conflict resolution skills, and investigative skills.


Education:

RN with a valid unrestricted nursing license.

At least 3 years of clinical experience; preferably in an acute clinical medical setting

Previous experience in Utilization Management, discharge planning, and home health or rehabilitation are preferable

Searchable Keywords: Clinical Advisor - Utilization Review / gj-mo

Years of Experience Required: At Least 3 Years

Expected Travel Time: None