DescriptionDo you have a passion for being able to impact and influence the direction of people’s thinking through the impactful delivery of clinical best practices? Do you enjoy creating goals using models and metrics to support clinical programs? If so, this role may be for you! This position will require about 20-30% travel split between local and overnight throughout the assigned area. You will develop and maintain key relationships to optimize business results.
The ideal candidate for this position must live within a commutable distance to Federal Way, WA. This position will be split between visiting provider offices throughout the territory and working in the Federal Way office. This individual will also need to have competent presentation skills and a professional demeanor.
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.
- Participate in strategic discussion, creation, implementation of interventions to address clinical utilization.
- Bachelor’s Degree in health and/or business-related field or work experience equivalent.
- Registered Nurse, licensed in WA or the ability to license in WA.
- Critical thinker with the ability to analyze reports and act on data.
- Proficient PC skills (including MS Word, Excel and Access) required.
- Excellent communication skills, written and verbal.
- Demonstrated presentation skills.
- Strong organizational skills.
- 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 patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will 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.
- Background in case management, utilization management and payer experience preferred
Scheduled Weekly Hours40