Clinical Advisor - Utilization Review Louisville – 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 Advisor - Utilization Review
Assignment: Clinical Intake Team
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 Clinical Advisor will analyze data and implement cost savings strategies for the Commercial side of business, focusing on reducing unnecessary services and increasing performance measurement. Implements high quality, cost - effective, and appropriate alternatives of care in a coordinated effort with the patient, patient's family, physicians, and other health care providers. Documents potential quality of care issues and refers them to the appropriate party.

Key Competencies

• Leveraging Technology: You are technological savvy and know how to appropriately share and use your knowledge to improve business results.
  
• Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
  
• Is Accountable: You meet clearly stated expectations and take responsibility for achieving results.
  
• Clinical Knowledge: You understand clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications of such programs
  
• Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.

• Active RN or LPN license in the state(s) in which the nurse is required to practice
  
• Ability to be licensed in multiple states without restrictions
  
• At least 3 years of clinical experience; preferably in an acute care, skilled or rehabilitation clinical setting
  
• Previous experience in Utilization Management, discharge planning, and home health or rehabilitation are preferable
  
• Ability to work independently under general instructions and with a team

• Health Plan experience
  
• Call center or triage experience
  
• Previous experience in utilization management, discharge planning and/or home health or rehab