Humana Onsite Registered Nurse in Cincinnati, Ohio

Role:Onsite Registered Nurse

*Assignment: *(Onsite and WAH)

Location:Cincinnati, OH (University of Cincinnati Hospital)

Humana’s 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. Humana’s 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 a part of our Clinical Space – as a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.

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

Key Competencies

  • Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.

  • Accountability: Meets established expectations and takes responsibility for achieving results; encourages others to do the same.

  • Customer Focus: Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.

  • Executes for Results:Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.

Role Essentials

  • Active RN license in the state(s) in which the nurse is required to practice

  • Ability to be licensed in multiple states without restrictions

  • Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting

  • Ability to work independently under general instructions and with a team

  • Valid drivers license and/or dependable transportation necessary (variable by region)

Role Desirables

  • Education: BSN or Bachelor’s degree in a related field

  • Health Plan experience

  • Previous Medicare/Medicaid Experience a plus

  • Call center or triage experience

  • Previous experience in utilization management, discharge planning and/or home health or rehab

  • Bilingual is a plus

Additional Information

Humana is an organization with careers that change lives—including 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 you’re 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 now, or join our Talent Network so you can stay informed and up to date on what’s happening at Humana.

Title: Onsite Registered Nurse

Location: OH-Cincinnati

Requisition ID: 178548