Senior Case Manager – Full Time/Weekends – Tampa, FL job – Humana – Tampa, FL

Be a part of our Clinical Space – as a Case Manager 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

Qualifications

Role Essentials

Active RN license in the state of Florida

Ability to be licensed in multiple states without restrictions

Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting

Ability to work independently under general instructions and with a team

Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana At Home’s systems if 10Mx1M

This role will include weekend shifts and working both 8 and 10 hour shifts.

Role Desirables

Education: BSN or Bachelor’s degree in a related field

Health Plan experience

Previous Medicare/Medicaid Experience a plus

Call center or triage experience

Previous experience in utilization management, discharge planning and/or home health or rehab

Bilingual is a plus

Additional Information

Humana is an organization with careers that change lives—including 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 you’re 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.

Schedule

:

Full-time

Primary Location

:

US-FL-Tampa

Role

:

Clinical Innovations and Health Practitioners

Work Environment Type

:

Office, Virtual/Work At Home

Travel

:

Yes, 5 % of the Time

About secureteam

secureteam
A Computer Programmer whose articles got mentions from the likes of The New York Times, Kissmetrics and AllTopStories. He writes articles, novels and poems; spends most of his time reading everything he could get his hands on. He is currently pursuing his Masters from The University of Illinois and holds a Bachelors in Electronics Engineering from the University of California. He is a programmer, a motivational writer and speaker.

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