Humana Utilization Review – Frontline Leader RN (Central Standard Time Zone) in Chicago, Illinois

Role:Utilization Review – Frontline Leader RN (Central Standard Time Zone)

Assignment:Sr. Segment

Location:Work-at-Home (Nationwide anywhere in the US) Preference MN or IL

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.

Assignment Capsule

Be part of a clinical leadership team, where we provide innovative health solutions to members and providers.

Humana is seeking a Utilization Review Frontline Leader RN 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 Utilization Review Frontline Leader RN 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

Role Essentials

  • Current RN license in the state in which the nurse is / will be required to practice

  • Ability to be licensed in multiple states without restrictions

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

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

  • Prior supervisory experience

  • Must have good typing skills and proficiency using MS Office Word, Outlook and Excel

  • Ability to work independently under general instructions and with a team

  • Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required Role Desirables

  • BSN or Bachelor’s 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 Reporting Relationships

  • You will have 15 direct reports, and you will report to a manager.

Additional Information

Interview FormatAs part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

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.

Title: Utilization Review – Frontline Leader RN (Central Standard Time Zone)

Location: US

Other Locations: US-Illinois-Chicago, US-Minnesota-Minneapolis

Requisition ID: 192794

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.