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Frontline Leader - Utilization Review - Transition of Care
- Minnetonka, MN -
Humana's 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. Humana's 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.
Humana offers an attractive comprehensive salary and benefits package! Be part of a clinical leadership team, where we provide innovative health solutions to members and providers.
Humana is seeking a Clinical Innovations Front Line Leader who will hire, lead, and develop clinical and non- clinical professional associates. The Front Line Leader will collaborate with other health care givers in reviewing actual and proposed medical care and services against established Guidelines. As a Clinical Innovations Front Line Leader you will:
- Report trends
- Develop system-view recommendations
- Implement appropriate actions to control trend
- Create and conducts provider outreach initiatives
- Ensure compliance with regulatory requirements
- Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally
- Recommend alternatives if appropriate using your knowledge of clinical protocols
- Identify members for specific case management and / or disease management activities
- Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions
- Current RN license
- Ability to be licensed in multiple states without restrictions
- Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Prior supervisory experience
- Case Management Experience
- Ability to work independently under general instructions and with a team
- Valid drivers license and/or dependable transportation necessary
- BSN or Bachelors degree in a related field
- Health Plan experience
- Prior Medicare / Medicaid experience
- Call center or triage experience
- May substitute equivalent education and/or experience for degree
- Previous experience in utilization management, discharge planning and/or home health or rehab
- Bilingual is a plus
- You will have 15-25 direct reports, and you will report to a director. This area is under the leadership of the SVP & Chief Operating Officer.
At Humana, we know your well-being is important to you, and it's important to us too. That's why we're committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.
Healthcare-Administrative and Support Services