Case Management RN (Fully Bilingual, Minimun of 3 consecutive year of Clinical exp a Must) HMS - Humana (Puerto Rico)
* Role: * RN Case Management – San Juan Office
*Location: * Humana 383 FD Roasevelt Ave. Hato Rey. El Mundo office * *
* Are you a fit? *
Do you enjoy working with medical members? Do you have a desire to be in a position where you can provide guidance to our member population as it is related to their health care needs? If so then read on!
* Assignment Capsule *
You will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.
* Telephonically 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
Role Essentials
* Active RN license in Puerto Rico and/or Active RN license in Florida, USA.
* Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. See Additional Information on testing
* Bachelor Degree in Nursing from accredited University.
* Affiliated with the CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico) IF you have an Active RN license in FL, USA ,this is not a mandatory requirement
* Prior clinical experience in an acute care, skilled nursing, rehabilitation, OR discharge planning
* If youdo not have FL RN license: You must apply and achieve FL RN license within 30-45 days of employment or must successfully complete and pass the NCLEX exam within 30-45 days.
o You need to have 3 consecutive years of experience as RN (no gaps in employment) andapply for FL RN. OR,
o You can have under 3 yrs. experience as RN IF you have attended to one of the accredited schools in PRin order to take NCLEX exam
* Ability to work independently under general instructions and with a team
* Able to work 8:00 AM - 6:00 PM (Occasionally may be required to work overtime and/or weekends/)/
Role Desirables
* Health Plan experience
* Previous Case Management Experience
* Call center or triage experience
* Previous experience managing Medicare members
Additional Information
Language Proficiency Testing
Any Humana associate who speaks with a member in a language other than Spanish must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
**Title:** *Case Management RN (FULLY Bilingual, Minimun of 3 consecutive year of Clinical exp a MUST) HMS – San Juan*
**Location:** *Puerto Rico-San Juan*
**Requisition ID:** *184622*
Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.