Clinical Policy, Medicare RN – 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: Clinical Policy, Medicare RN
Location: Louisville, KY

Are you a fit?
Would you like to work within the Clinical Policy area? Do you have a desire to be in a position where you can help provide guidance to our Medicare member population as it is related to their health care needs? If so then read on!

Assignment Capsule

You will be responsible for reviewing CMS National Coverage Decisions (NCDs) and Local Coverage Decisions (LCDs) and determine how these decisions potentially impact Humana clinical policies. You will then present these findings to the Technology Assessment Forum (TAF) Committee (TAF is Humana's Medical Policy Committee).
You will be instrumental in working within our Medical Pipeline committee by identifying and tracking CMS policy decisions as they are being developed.
You will work closely with our Medicare Clinical Review Staff to assist with Clinical Policy issues. You will perform ad-hoc literature reviews for internal associates (ie: Regional Medical Directors) specific to Medicare.

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, are self-directed and take responsibility for achieving results.
  
• Clinical Knowledge: Leverages expert scientific/medical information to assist in developing medical policies to guide consumers toward more positive health and well-being outcomes.
  
• Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.

Role Essentials

• Active RN license
  
• Three years prior clinical experience
  
• Ability to work independently under general instructions and with a team
  
• Ability to compile and analyze available peer-reviewed medical literature on emerging technologies to develop clinical policies.
  
• Strong analytical, communication, presentation, web navigation and writing skills.

Role Desirables

• Education: BSN or Bachelors degree in a related field
  
• Previous Health Plan experience, particularly in Medicare

Reporting Relationships
You will report to a Manager. This area is under the leadership of the SVP & Chief Operating Officer.

Apply Here