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Become a part of our caring community and help us put health first. Works with Utilization Review staff relative to data tracking for performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process.
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We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
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Previous experience in utilization management, case management, discharge planning and/or home health or rehab. Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company.
$69,800 - $96,200 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
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As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients.
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The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.
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Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment. About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization.
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Strong background in home health clinical operations and quality assurance, highly preferred. Reviews available patient information related to the case, including disciplines required, to determine home health or hospice needs.
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Become a part of our caring community and help us put health first The Clinical Manager coordinates and oversees all direct care patient services provided by clinical personnel. About Us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization.
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Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Competently performs patient care assignments and staff management activities.
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Analyzes situations, identifies problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. Conducts/delegates the assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies.
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Instructs and guides clinicians to promote more effective performance and delivery of quality home care services, and is available at all times during operating hours to assist clinicians as appropriate.
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Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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Prior/current experience in Utilization Management/Utilization Review with MCG. Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care.
$69,800 - $96,200 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago
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