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Clinical Advisor - Transplant Management
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Clinical Advisor - Transplant Management; | Humana ; | Louisville KY 40202 USA; | Full Time .
Requirements; | Details; | Locations; | Contact .
Job Description: .
Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies, with approximately 11 million medical members located primarily in 15 states and Puerto Rico. 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.Over its 43-year history, Humana has consistently seized opportunities to meet changing customer needs.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.
Assignment SheetClinical Advisor - Transplant ManagementExemptAssignment Summary:The Transplant Management Clinical Advisor guides Humana members through solid organ and bone marrow transplantation by providing information and resources that enable the member to make informed decisions. The Clinical Advisor will be the single transplant point of contact who ensures the members' understanding of their transplant benefits. By steering members to the Humana National Transplant Network, the Clinical Advisor will maximize the available transplant benefits. The Clinical Advisor must have the ability to identify potential barriers for members receiving transplant services, provide appropriate authorizations related to transplant or assist in obtaining those authorizations, monitor and evaluate members' needs post transplant 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. In particular, The Clinical Advisor will provide network support to the Humana Transplant Network and claims support to the dedicated transplant claims units. The Clinical Advisor will participate in the development and implementation of Transplant Management's Quality Management System, policies and procedures and metrics..Additional Competencies (if applicable):(Demonstrating Level of Knowledge, Skills, Behaviors)
Have knowledge of transplant related services and processes
Must possess a strong knowledge of health care delivery systems
Possess advanced knowledge of benefit plan design and interpretation
Demonstrate a high level of expertise in the use with PC based computer applications and the internet
Possess excellent written and verbal communication skills,
Skilled in the areas of problem-solving and data analysis
Demonstrate strong interpersonal skills, skills in conflict resolution and stress management
Must be able to work interdependently within a team setting
Must possess interpretive, intuitive and investigative skills
Must be able to make appropriate decisions in the face of ambiguity
Ability to work autonomously in work at home environmentEducation:
RN with a 4 year degree
Ability to be licensed in multiple states; without restriction
Have at least three years clinical nursing experience, preferable in critical care or oncology nursing
Certified Case Manager ( CCM) preferred
BI-lingual (Spanish) is a plusAdditional Requirements
Ability to manage time and resources effectively
DSL Access or Cable Modem accessibility
Designated/Secured work area to conduct business (i.e. home office)
Ability to work/train in Louisville for 2-4 weeks, plus additional travel as needed for ongoing training
Ability to work on a phone queue with a work schedule :8:30-5:00 PM EST .
Contact Name: http://www.humana.com/careers .
Email: Click Here (apply to job) .
Job Code: 13491 .
This opportunity presented by IMDiversity, Inc.
Applicant Category: Professional
Requisition Code: Work at home
Two Initials of Recruiter: bw
System Date: 01/24/2007
System Time: 14:37:25
Document Name(40): Clinical Advisor - Transplant Management
Source: IMDiversity.com - USA
SearchTerms: "work at home" "work from home"
URL(80): http://jobs.imdiversity.com/jobseekerx/ViewJob.asp?JobID=BNoqLL3%2FaX9XiYeykSSaT
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