Call Center Jobs

CallCenterJobs.com
Search Jobs | Job Seekers
Employers | Post a Job

View Job

RN Utilization Management SNF/Post-acute - GA & SC - (Role Number: 194095)

06/08/2018Call Center
Job Location:
Atlanta, GA
Metro Area:
GA - Atlanta
Company Name: Humana Inc.
Website:  Click to Visit
Role: RNUtilization Management SNF/Post Acute

Assignment: Medicare

Location: Georgia or South Carolina

 

The hours of this role are Mon-Fri, 8am-5pm est

 

Assignment Capsule

 

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

Role Essentials

  • Active RN license without restrictions
  • Ability to be licensed in multiple states without restrictions
  • Prior clinical experience preferably in an post acute setting
  • Previous experience in utilization management
  • Excellent computer skills and ability to easily navigate multiple applications
  • 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

  • Health Plan experience
  • Previous Medicare/Medicaid Experience a plus
  • Call center or triage experience
  • Bilingual is a plus

 

Interview Format

As 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.

 

Humana is an organization with careers that change livesincluding 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 youre 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.

 
Apply Online Back