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Utilization Review Frontline Leader - RN Supervisor - Metairie or Baton Rouge LA - (Role Number: 18

02/05/2018Call Center
Job Location:
Metairie, LA
Metro Area:
LA - New Orleans
Company Name: Humana Inc.
Website:  Click to Visit
Role: RN Frontline Leader - Utilization Review

Assignment: Medicare

Location: Metairie or Baton Rouge, LA

Office based position with possibility of work from home 1 day per week after 6 month orientation


Humanas 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. Humanas 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 Clinical Innovations Front Line Leader 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 Clinical Innovations Front Line Leader 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

Key Competencies

  • Interpersonal Effectiveness: Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships.
  • Leads Positively: Leads by example to cultivate a climate of motivation, positive energy and meaning in work. Assesses, selects, recognizes, develops, and empowers diverse talent.
  • Accountability: Meets established expectations and takes responsibility for achieving results; encourages others to do the same.

Role Essentials
  • Current RN license
  • Ability to be licensed in multiple states without restrictions
  • Progressive clinical experience in an acute care, skilled or rehabilitation clinical setting
  • Experience in utilization management
  • Proven ability as a mentor, coach, preceptor or SME
  • Ability to work independently under general instructions and with a team


Role Desirables

  • BSN or advanced degree 
  • Health Plan experience
  • Prior Medicare  or managed care experience
  • Call center or triage experience


Reporting Relationships
  • You will have 5-8 direct reports, and you will report to a Clinical Manager. 

Additional Information


At Humana, we know your well-being is important to you, and its important to us too. Thats why were 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.


After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on whats happening around our organization in the changing world of healthcare.

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