Clinical Advisor-RN – Daytona Beach

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. 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.

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.

Case Manager, RN
Daytona, FL

Job Summary:

Works with members to assess their care needs, assist in planning and implementation of interventions to meet those needs, assists in coordinating services, and monitors and periodically evaluates the case management plan against the member's personal health care goals. Document this case management process in the appropriate systems as defined by management.

Collaborates with the member's provider team to monitor provider-based care and discharge planning at all levels of care in accordance with established criteria and makes recommendations to improve such efforts where appropriate. Utilizes knowledge of benefit plan design and care alternatives available within the community and nationally in order to recommend services.

Identifies candidate for specific disease management activities or interventions by utilizing established screening criteria.

Maintains an awareness of clinical and social resources available in the community in which the member resides.

Performs duties consistent with all State and Federal regulatory requirements, accreditation organization guidelines, and Humana guidelines.

MINIMUM QUALIFICATIONS (Experience, Education & Special Certifications)

Active Florida RN license with 3-5 years clinical experience preferably as a case manager, utilization review nurse, or discharge planner.

BSN or Bachelors degree in a related field desired.

Case Management Certification desired.

Strong leadership and communications skills that assist the applicant in working directly with members, families, and providers with minimal supervision.

Ability to operate a personal computer and standard software programs required.
Ability to type / keyboard a minimum of 40 wpm desired.

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