Clinical Advisor - Utilzation 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

Clinical Advisor - UR/UM
Full Time
Location: Green Bay



Assignment Summary:

The Clinical Advisor will analyze data and implement cost savings strategies for the Commercial side of business, focusing on reducing unnecessary services and increasing performance measurement. 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 or LPN 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 - Utilzation Review / gj-mo

Years of Experience Required: At Least 3 Years

Expected Travel Time: None