CCM Triage-Bariatric Clinical Advisor – Louisville

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.

Role: Clinical Innovations / Clinical Advisor, RN
Assignment: Case Management Triage/ Bariatric Management
Location: Louisville, KY

Are you a fit?
Do you enjoy working with medical members? Do you have a desire to be in a position where you can 'provide guidance to our member population as it is related to their health care needs? If so then read on!

Assignment Capsule
The Case Management Triage/ Bariatric Clinical Advisor guides Humana members through Bariatric Surgery Process by providing information and resources that enable the member to make informed decisions. The Clinical Advisor will be the Bariatric point of contact that ensures the members' understanding of their Bariatric benefits. By steering members to Bariatric Centers of Excellence that are Humana Participating Providers, the Clinical Advisor will maximize the available Bariatric benefits.

The Clinical Advisor must have the ability to identify potential barriers for members receiving Bariatric services, provide appropriate authorizations related to Bariatric Surgery or assist in obtaining those authorizations, monitor and evaluate members' needs post Bariatric related services, and know when to follow-up with a member. This is achieved through one-on-one dialogue with the member, thus the ability to maintain a caseload is required.

The Clinical Advisor will serve as a resource for internal Humana departments and external business partners. The Clinical Advisor will participate in the development and implementation of CCM Triage & Bariatric Management's Quality Management System, policies and procedures and metrics.

The Clinical Advisor will be cross trained to assist with CCM Triage. This involves research of case information, analyzing and reporting this information. Processing referrals to multiple Humana Programs and outsourced vendors.

Key Competencies

• Communication: The clinical advisor identifies and understands the needs and perspectives of others. He/she understands the audience and tailors delivery accordingly; shares information appropriately. The clinical advisor presents information and/or recommendations verbally, graphically and/or in writing that is articulate and succinct.
• Problem Solving: The clinical advisor proactively identifies and evaluates problems. He/she identifies appropriate subject matter experts and other information resources to resolve problems. The clinical advisor is able to collect, analyze, and draw conclusions from information and is able to differentiate between symptoms and root cause--effectively handles resolution or hand-off of both components. Implementation/Execution: The clinical advisor effectively leverages available resources (financial, people, time) to accomplish objectives and maximize return on investment. He/she makes appropriate decisions in the face of ambiguity. Anticipates and resolves barriers and constraints.
  
• Technology: The clinical advisor chooses and adeptly uses appropriate technology tools, methodologies and solutions. From the telephone to the computer, the clinical advisor is at home with electronic technology and uses it as a matter of course. The Internet is a familiar place where the clinical advisor is able to navigate and find resources, information, and tools to help guide members. The clinical advisor is able to learn via the internet and within a virtual environment.
  
• Assessment: The clinical advisor evaluates members with specific diagnoses, identified as having been historically associated with opportunities for improved discharge planning. Re-assessment occurs on a cycle consistent with the Clinical advisor's impression of the member's needs and clinical status.
  
• Planning: The Clinical advisor works with the member, guardian, provider, and other members of the health care delivery team to identify the member's need and resources to meet those need
  
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