RN – Provider Clinical Liaison – Greater Seattle area
- Federal Way, WA
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 Humana's 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.
The ideal candidate for this position must live within a commutable distance to Federal Way, WA. This position will be split between visiting provider offices throughout the territory and working in the Federal Way, WA office. This individual will also need to have competent presentation skills and a professional demeanor.
- Bachelor's Degree in health and/or business-related field.
- Registered Nurse, licensed inWA 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.
- Demonstratedpresentation 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 Humana's Tuberculosis (TB) screening program. If selected for this role, you may be required to be screened for TB.
- This role is a part of Humana's Driver Safety program and therefore requires the 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 be available for some overnight travel.
- Background in case management, utilization management and payer experience preferred
- Health-related or health-business-related graduate degree preferred
- Prior experience working with physicians or hospital providers
Ideal candidates must live in the Greater Seattle area to be considered for this position. The position will be 50% in office/50% travel to provider clinics in the Greater Seattle area.
Scheduled Weekly Hours
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