Registered Nurse, Author by Humana
Humana

Greenville, South Carolina

Posted in Insurance
10 days ago


Job Info


Description

Author, recently launched by Humana, is a service experience designed to meet the whole-health needs of the people we serve. Created to innovate with the speed and agility of a modern start-up and backed by the insights and scale of Humana, Author is pioneering a customer-centered experience designed to foster trusting relationships with members to help them achieve their best health.

Dedicated to simplifying the healthcare experience and helping people navigate their healthcare journey, Author is leveraging digital technologies to eliminate fragmentation and systematic friction for members and providers.

We are seeking individuals who are passionate about solving tough problems as we forge a new path for the healthcare industry. As a member of the Author team, you will have the opportunity to make a difference in the lives and health of the members we serve.

The Billing & Enrollment Professional 2 Is responsible for the accurate enrollment and billing process for an insurance organization. The Billing & Enrollment Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate course of action.

Responsibilities

Responsibilities

  • Utilize clinical judgement to design, implement, and monitor evidence-based actionable care plans within a disease management/care coordination program that are aligned with the Member's goals in collaboration with caregivers, the Humana Author Care team, primary care providers, and other members of the health care team
  • Timely completion of initial and ongoing assessments as needed
  • Facilitation of member and caregiver access to community resources
  • Works in conjunction with a Care Team to be the liaison between the Member and barriers to their whole health
  • Implementation of assessment tools to identify health risks, documenting progress towards reducing the Member's health/social/emotional risk, and discussing the findings of the case with Care Team members to provide optimal whole health care
  • Assist Members in identifying, measuring, tracking, and achieving whole health goals
  • Engaging with Members in their home environment as needed to develop and collaborate on care plans to increase their whole health experience and help prevent unnecessary hospitalizations
  • Empower Members to guide their physical, environmental, and psycho-social health issues with their Care Team
  • Collaborate with and establish strong personal relationships with Members, partners, providers, and the Humana Author team
  • Travel within the local region and occasional interstate travel may be required
  • Provision of guided group discussions/educational classes for Members within an Author Community Center. Actively participates in educating care team members, including PCPs and support staff, on Care & Disease Management principles. Education including but not limited to: the development of assessment and intervention/treatment options as appropriate to the team member's scope.
  • May serve as the Humana Author representative on Humana Level Care & Disease Management planning and program development forums and work groups
  • Ability and willingness to be an instrumental part of a growing team by joining work groups to assist and guide the development of the Author team in South Carolina
Required Qualifications
  • Registered Nurse with 2 years of experience of in home case/care management
  • Experience working with the adult population
  • Knowledge of community health and social service agencies and additional community resources
  • Ability to travel to member's residence within 30 to 40 miles
  • Exceptional communication and interpersonal skills with the ability to quickly build rapport
  • Ability to work with minimal supervision within the role and scope
  • Ability to use a variety of electronic information applications/software programs including electronic medical records
  • Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel
  • Excellent keyboard and web navigation skills
  • Ability to work a full-time (40 hours minimum) flexible work schedule
  • This role is a part of Humana's Driver Safety program and therefore requires and 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 have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you work
  • Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana At Home systems if 5Mx1M
  • This role is considered patient facing and is part of Humana At Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  • Valid driver's license, car insurance, and access to an automobile
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
  • BSN
  • 3-5 years of in home assessment and care coordination experience
  • Experience with health promotion, coaching and wellness
  • Previous managed care experience
  • Bilingual - English, Spanish
  • Certification in Case Management
  • Motivational Interviewing Certification and/or knowledge
Additional Information

This role will be a remote position in South Carolina until September 2021. At that time, associates will be asked to work in one of our offices located at either 4900 O'Hear Avenue, North Charleston, SC 29405 or 141 Traction Street, Greenville, SC 29611.

#Author

Scheduled Weekly Hours

40



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