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Clinical Advisor - Bariatric Management
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Clinical Advisor - Bariatric 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 Summary:The Bariatric Management Clinical Advisor guides Humana members in need of a bariatric surgery by providing information and resources that enable the member to make informed decisions. The Clinical Advisor will be the single bariatric surgery point of contact that ensures the members' understanding of their bariatric surgery benefits. By steering members to Humana Par/SRC Centers of Excellence, the Clinical Advisor will maximize the available bariatric surgery benefits. The Clinical Advisor must have the ability to identify potential barriers for members receiving bariatric surgery services, provide appropriate authorizations related to transplant or assist in obtaining those authorizations, monitor and evaluate members' needs post surgery, 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. The Clinical Advisor will participate in the development and implementation of the Bariatric Management Quality Management System, policies and procedures and metrics..Additional Competencies (if applicable):(Demonstrating Level of Knowledge, Skills, Behaviors)
Have knowledge of bariatric surgery and related services,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 the bariatric surgery setting
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 .