Assignment: Humana Government Business - Clinical Guidance
Location: Work at Home- Nationwide (Central and Eastern time zones preferred)
Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their families. For more than 20 years, Humana Military has strived to create better health outcomes and simplified experiences for millions of beneficiaries across the United States through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, and progressive approaches to care drive Humana Military to be a thought leader in the industry and an essential partner to the Government.
The New Beginnings Clinical Advisor will have personal interaction with TRICARE beneficiaries identified for New Beginnings program through analytics or referral. The New Beginnings advisor will provide prenatal education and resources on pregnancy, pregnancy-associated conditions, and chronic health conditions affecting pregnancy. The NB Advisor will provide ongoing support for beneficiaries from the earliest stages of pregnancy up to six weeks following birth or longer for infants in NICU. The NB Advisor will serve as a point of contact for pregnant beneficiaries assisting in planning, coordinating, implementing, monitoring, and evaluating medical services needed to meet the healthcare needs of the TRICARE beneficiaries enrolled in the program. The New Beginnings Clinical Advisor will coordinate with hospitals, attending physicians, the beneficiary’s PCM, and other members of the healthcare team to provide ongoing clinical review to include authorizations, concurrent review, and discharge planning services should a mother or infant required extended care. The NB Clinical Advisor will also coordinate care with case managers within HGB’s Integrated Care Team, MTF case managers, and facility case managers. UM support for inpatient NICU and new mothers. Perform all duties within the scope of his/her practice.
Our Department of Defense Contract requires U.S. citizenship for this position.
Utilize applicable sources of information to identify, assess, and enroll patients eligible for the New Beginnings Program. Contact enrolled beneficiaries via outbound calls or preferred method of contact, to assess and provide guidance/education/resources per protocols. Provides a point of contact for beneficiaries with pregnancy / post-partum related needs. Update the Care Management System per HGB Medical Affairs policies and procedures; complete all reporting requirements in a timely manner
Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the New Beginnings program, including conducting authorizations, concurrent review, and discharge planning activities for NICU admissions. Will follow admissions through discharge, coordinating care and / or referring cases to Case Management members of the ICT as needed based upon the beneficiaries needs and clinical condition. Maintain beneficiary’s privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.
Coordinate and collaborate with other external programs and / or members of the ICT to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting all interventions and outcomes for beneficiaries within the case management and ICT team.
Registered Nurse with current in state RN license (minimum Associate Nursing or Diploma Nurse)
Case Management Certification (CCM)
Three years’ (3) experience in maternal / child nursing with NICU experience
Interqual (or Milliman) knowledge
Good communication skills, verbal and written
Good organizational skills
U.S. Citizenship is required by our Department of Defense contract
Bachelor’s degree in nursing / healthcare
Two (2) years case management experience
Telecommuting is allowed.
Additional Salary Information: Salary will be paid based on Education and experience / Diploma Nurse with appropriate experience do qualify. My selections were limited to listing only the 2 year degree.
Internal Number: 188167
Humana Inc. (NYSE: HUM) is focused on improving the health of the communities we serve by making it
easy for people to achieve their best health through clinical excellence and coordinated care.
Our diverse lines of business work to serve all types of consumers. From families to seniors to military members to self-employed individuals, there is a plan to meet many unique needs. Humana's associates and corporate leaders are committed to customer service. Our team uses innovation to deliver results to our consumers.