Home Health Utilization Workflow Manager - Weekends Required
Bankers Healthcare GroupSalary not specified
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates must be a Registered Nurse (RN) with unrestricted license or an independent licensed clinical social worker, possessing at least 5 years of previous clinical experience in utilization management, and a minimum of 2 years of indirect or direct leadership experience. They should have comprehensive knowledge of Microsoft Office applications, including PowerPoint, Word, Excel, and Outlook, along with familiarity with regulatory requirements and National Committee for Quality Assurance (NCQA) standards.
Responsibilities
The Strategy Advancement Advisor will develop and implement utilization management strategies aligned with organizational goals, ensuring the efficient use of healthcare resources and maintaining high-quality patient care. They will identify opportunities for cost savings through effective utilization management practices, monitor and analyze utilization data, and implement cost-effective measures. The Advisor will establish standardized protocols and workflows across the enterprise, lead UM annual evaluation activities, and facilitate communication and coordination between various departments, providing strategic planning support, conducting data analysis and reporting, and collaborating with stakeholders to ensure cohesive utilization management practices. They will also advise executives on functional strategies and exercise independent judgment in complex decision-making.
Skills
Data Analysis
Strategic Planning
Healthcare Utilization Management
Cost Containment
Business Intelligence
Policy Development
Leadership
Project Management
Humana
Health insurance provider for seniors and military
About Humana
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees