RN - Provider Clinical Liaison - WAH OR ID MT or UT

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Description

RN - Provider Clinical Liaison contributes to administration of utilization management. The RN - Provider Clinical Liaison work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth clinical evaluation of variable factors.

Primary responsibilities include:

Attend meetings with physician groups to address areas of clinical utilization.

Educate physician groups on the principles of medical management (CM, DM, UM).

Work with physician groups and other Humana associates to identify opportunities to streamline work processes.

Collaborate with Humana team members in engaging physician groups (Operations, QI, Finance, MRA).

Utilize reports to identify clinical indicators requiring intervention.

Serve as primary resource for Humana's clinical programs to internal and external audiences as required.

Improve relations with physician, hospital and community groups addressing health care.

Create and participate in strategic discussion and implementation of interventions to address clinical utilization at a systems level.

Responsibilities

The ideal candidate for this position would have a strong desire to work collaboratively with internal and external partners to improve clinical outcomes of a shared population. The candidate should live in either Washington or Oregon and be within a reasonable distance from an airport. This position will be mostly virtual (telecommuting) but will have some travel expectations once it's considered safe to do so by local health authorities. Reasons for travel could include visiting provider offices throughout the territory, business meetings, and educational offerings. This individual will also need to have competent presentation skills and a professional demeanor.

Required Qualifications

Bachelor's Degree or equivalent relevant experience

Registered Nurse, licensed in OR, UT, MT, or ID or the ability to license in those states

3 years of experience in utilization management/case management/or other experience working with a health plan or provider office

Critical thinker with the ability to analyze reports and act on data.

Proficient PC skills (including MS Word, Excel and Power Point) required.

Excellent communication skills, written and verbal.

Demonstrated presentation skills.

Strong strategic thinking and business planning capabilities; organized and detail-oriented

Ability to work independently under general instructions and with a team

Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.

This role is considered provider facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you may be required to be screened for TB.

This role is a part of Humana's Driver Safety program and therefore requires the individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Must be available for some overnight travel.

Preferred Qualifications

Background in case management, utilization management and/or payer experience preferred

Health-related or health-business-related graduate degree preferred

Prior experience working with a health plan, physicians groups, and/or hospital providers

Additional Information

The candidate must reside currently in either Oregon, Montano, Utah or Idaho and be willing to travel for business needs once community health leaders deem it's safe to do so. Anticipated travel should be less than 25%.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com