Onsite Commercial RN Case Manager – Jacksonville

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.





Over its 46-year history, Humana has consistently seized opportunities to meet changing customer needs.


Commercial Case Manager Job Description
Role: Clinical Advisor

The Commercial Case Management Clinical Advisor supports Humana members by identifying and utilizing appropriate healthcare resources most consistent with the member's needs and by providing guidance along the healthcare continuum. The clinical advisor works with identified health plan members to assess their care needs, assist in coordinating interventions and services to meet those needs, and communicating with members, providers, and Humana associates to promote efficient use of the healthcare system. The clinical advisor utilizes knowledge of benefit plan design and care alternatives available within the community and nationally in order to recommend services that represent the delivery of appropriate health care services for Humana Plan members as ordered by the member's care provider(s). This work requires frequent onsite visits to hospitals and/or other healthcare facilities and the ability to work via cable or DSL modem from home as needed in a secure environment where confidentiality of member and company information can be maintained.

The Humana Commercial Case Management Clinical Advisor documents the clinical, financial variance, quality of life and client satisfaction outcomes. The Clinical Advisor documents any hospital or alternative level of care savings into the clinical documentation platform, documents any negotiated rates which result in case savings, documents Quality issues which may affect the clinical outcomes and reports these to the Quality Department for review and appropriate actions.

In general, Clinical Advisors are aware of and abide by all government and
regulatory statutes which apply to the interactions with members, sharing
of personal health information and maintaining member privacy. Clinical
Advisors verify and obtain member consent when discussing or sharing PHI
and obtain consent for case management services. Case managers act as
member advocates, monitor for member safety, provide member
confidentiality and adhere to all ethical, legal and regulatory standards in
the performance of case management services.
Core Competencies:
oCommunication: The Clinical Advisor identifies and understands the needs and perspectives of others. He/she understands the audience and tailors delivery accordingly; shares information appropriately. The clinical advisor presents information and/or recommendations verbally, graphically and/or in writing that is articulate and succinct.
oProblem Solving: The Clinical Advisor proactively identifies and evaluates problems. He/she identifies appropriate subject matter experts and other information resources to resolve problems. The clinical advisor is able to collect, analyze, and draw conclusions from information and is able to differentiate between symptoms and root cause--effectively handles resolution or hand-off of both components. Implementation/Execution: The Clinical Advisor effectively leverages available resources (financial, people, time) to accomplish objectives and maximize return on investment. He/she makes appropriate decisions in the face of ambiguity. Anticipates and resolves barriers and constraints.
oTechnology: The Clinical Advisor chooses and adeptly uses appropriate technology tools, methodologies and solutions. From the telephone to the computer, the clinical advisor is at home with electronic technology and uses it as a matter of course. The Internet is a familiar place where the clinical advisor is able to navigate and find resources, information, and tools to help guide members. The Clinical Advisor is able to learn via the internet and within a virtual environment.
oAssessment: The Clinical Advisor evaluates members

Apply Here