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in Miramar, FL

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Hours Full-time, Part-time
Location miramar, Florida

About this job

Role: Case Manager - 1st shift

Assignment: Medicare

Location: Miramar, FL

Humana's dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana's Perfect Service means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule

Be a part of our Clinical Space -- as a Case Manager you will engage our members to develop lifelong wellbeing and health.

Humana is seeking a Case Manager who 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

Builds Trust : Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.

Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same.

Customer Focus : Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.

Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. Role Essentials

Active RN license in the state of Florida

Ability to be licensed in multiple states without restrictions

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

Ability to work independently under general instructions and with a team

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

Role Desirables

Education: BSN or Bachelor's degree in a related field

Health Plan experience

Previous Medicare/Medicaid Experience a plus

Call center or triage experience

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

Bilingual is a plus

Additional Information

Humana is an organization with careers that change lives---including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.