Job Description

Description

RN Provider Clinical Liaison contributes to administration of utilization management. The RN Provider Clinical Liaison work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth clinical evaluation of variable factors.

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 Humanas clinical programs to internal and external audiences as required.
Improve relations with physician, hospital and community groups addressing health care.
Create and participate in strategic discussion and implementation of interventions to address clinical utilization at a systems level.

Responsibilities

The ideal candidate for this position must live within a commutable distance to Federal Way, WA. When the pandemic resolves, this position will be split between visiting provider offices throughout the territory, working in the Federal Way, WA office, and working from home. This individual will also need to have competent presentation skills and a professional demeanor.

Required Qualifications

* 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 Power Point) required.
* Excellent communication skills, written and verbal.
* Demonstrated presentation skills.
* Strong strategic thinking and business planning capabilities; organized and detail-oriented
* 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 provider facing and is part of Humanas Tuberculosis (TB) screening program. If selected for this role, you may be required to be screened for TB.
* This role is a part of Humanas Driver Safety program and therefore requires the individual to have a valid state drivers 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.

Preferred Qualifications

* Background in case management, utilization management and payer experience preferred
* Prior experience working with physicians or hospital providers
* Bachelors Degree in health and/or business-related field.

Additional Information

Ideal candidates must live in the Greater Seattle area to be considered for this position. When it is considered safe to do so by local health authorities, the position will be a combination of working in the Humana office, traveling to provider clinics in the Greater Seattle area, and telecommuting.

Scheduled Weekly Hours

40