Humana Clinical Access Team - Telephonic RN in San Antonio, Texas

*Role: *Clinical Advisor, RN

Assignment: Clinical Access Team

*Location: *Work-at-Home, 9:30 - 6:00 EST

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.

Role Description

Be a part of our Clinical Space – as a Clinical Advisor RN on the Clinical Access Team 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.

  • Telephonically assist members with access to care issues
  • Facilitate and assess member’s clinical requests for access to care
  • Assess, provide education, research, and provide resolution
  • Work in a virtual call center environment and handle inbound calls in a call queue
  • Inbound and outbound calls to members, providers, internal departments working towards resolution

Role Essentials * Active, unrestricted RN license in a Nurse Licensure Compact (NLC) state: Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin. * Ability to be licensed in multiple states without restrictions * 3 years of prior clinical experience preferably in acute care, skilled or rehabilitation clinical setting * Ability to work independently under general instructions and with a team * Ability to work 9:30 to 6:00 EST

Role Desirables * BSN or Bachelor’s degree in a related field * Health Plan experience * Previous Medicare experience and familiarity with CMS guidelines * Call center experience * Previous experience in case management, discharge planning, home health, rehab, or DME * Bilingual - ability to speak fluently in both English and Spanish

Title: Clinical Access Team - Telephonic RN

Location: Texas-San Antonio

Requisition ID: 181871

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.