Onsite Utilization Review Nurse - Milwaukee, WI area
Location: Waukesha Wisconsin
Description: Humana is hiring Onsite Utilization Review Nurse - Milwaukee, WI area right now, this career will be placed in Wisconsin. Detailed specification about this career opportunity kindly see the descriptions. While this is a work at home opportunity, you will spend most of your day in the field at acute care facilities doing utilization review. You will collaborate with! other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria in an Acute Hospital setting. You will also be working closely with members and their families to determine best care practices.
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 an! d discharge planning
Key Competencies
Lev! eraging 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.
Qualifications
Role Essentials
Active RN/LPN license in ! the state(s) in which the nurse is required to practice
Ability to be licensed in multiple states without restrictions
Computer proficient in MS Office programs
Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Ability to work independently under general instructions and with a team
Valid driver’s license and/or dependable transportation necessary (variable by region)
This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
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
Bi! lingual is a plus
Reporting Relationships
You will re! port to a Manager or Supervisor.
Schedule
:
Full-time
Primary Location
:
US-WI-Waukesha
Role
:
Clinical Innovations and Health Practitioners
Work Environment Type
:
Virtual/Work At Home
Travel
:
Yes, 75 % of the Time
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Humana.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Tue, 09 Apr 2013 03:52:56 GMT
Apply Onsite Utilization Review Nurse - Milwaukee, WI area Here
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