Humana Patient Care Coordinator in Colorado Springs, Colorado

Role:Patient Care Coordinator, RN

Assignment:Humana Government Business

Location:Work at Home (Mountain, Central or Eastern time zones) or San Antonio, TX office

Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule

Be a part of our Clinical Space – as a Clinical Advisor you will engage our members to develop lifelong well-being and health.

Coordinate care for MHS beneficiaries receiving care outside the MTF. Monitor quality of care, identify, and document any potential quality issues regarding the patient’s care. Coordinate patient transfers and document appropriately in MSR. Review inpatient outlier cases, ensure appropriate and timely discharge planning, and refer to Tier III care management as needed.

Our Department of Defense Contract requires U.S. citizenship for this position. * Perform prior authorization reviews according to established HUMANA GOVERNMENT BUSINESS contractual requirements and guidelines to include timely data entry in MSR.

  • Perform accurate and timely assessment and concurrent review of outlier admissions using InterQual criteria and document review results in MSR. Pend cases appropriately to second level review and follow up with any denial activities as indicated.

  • Complete and document in MSR accurate and timely determinations of appropriateness of level of care: take appropriate actions to facilitate direction of patients to correct level of care as indicated by criteria.

  • Direct discharge planning appropriately; Maximize steerage of patients to the MTFs and preferred providers; Facilitate move to alternative levels of care in a timely manner.

  • Identify and follow patients requiring Tier II Care Management. Coordinate cases with and refer to tier III Care Manager and Disease Management Programs as appropriate.

Role Essentials

  • Registered Nurse with current in-state RN license

  • At least 3 years of varied clinical nursing experience

  • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Role Desirables

  • Utilization Review/Quality Management experience

  • BA/BSN degree

  • Computer skills, including data entry and use of data base systems

Additional Information

Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Title: Patient Care Coordinator

Location: Texas-San Antonio

Other Locations: US-Oklahoma-Tulsa, US-IN-Indianapolis, US-Pennsylvania-Pittsburgh, US-Kansas-Overland Park, US-KY-Louisville, US-Mississippi-Ridgeland, US-Illinois-Chicago, US-GA-Atlanta, US-North Carolina-Charlotte, US-OH-Cincinnati, US-South Carolina-Lancaster, US-AR-Rogers, US-AL-Birmingham, US-Idaho-Meridian, US-FL-Tampa, US-TN-Brentwood, US-Colorado-Colorado Springs, US-Louisiana-Metairie, US-Michigan-Troy, US

Requisition ID: 174341