Clinical Advisor RN with license (Office)- Bilingual - San Juan

Role: Clinical Innovations / Clinical Advisor, RN

Assignment:

Location: San Juan

Are you a fit?

Do you enjoy working with medical members? Do you have a desire to be in a position where you can provide guidance to our member population as it is related to their health care needs? If so then read on!

Assignment Capsule

You will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.

Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design

Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally

Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols

Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria

Conduct admission review, post-discharge calls and discharge planning Key Competencies

Leveraging Technology: You are technological savvy and know how to appropriately share and use your knowledge to improve business results.

Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

Is Accountable: You meet clearly stated expectations and take responsibility for achieving results.

Clinical Knowledge: You understand clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications of such programs

Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience. Role Essentials

Active RN license in Puerto Rico

Associated with the CPEPR (Colegio de Profesionales de Enfermera de Puerto Rico)

Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting, discharge planning

Ability to work independently under general instructions and with a team

Bachelor Degree in Nursing

Valid drivers license and/or dependable transportation necessary (variable by region)

Able to work within strict timeframes

Bilingual

Role Desirables

Health Plan experience

Previous Case Management Experience

Call center or triage experience

Previous experience in utilization management, discharge planning and/or home health or rehab

Previous experience managing Medicare members