Role: RN Case Management - Fully Bilingual Spanish/English - VSP (Temporary role with limited benefits 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 VSP associates with Humana work flexible hours to meet business needs, with no guaranteed minimum or maximum number of hours in any week. VSP associates are paid hourly and receive limited benefits. Benefits: Paid Time Off (PTO), Eligibility to participate in Humana's Partnership Savings Plan - Associates will be automatically enrolled in the 401K (accounts vest automatically on day one). Business Travel Accident Insurance. Associate Well-being Programs (WOW, EAP, Great Deals, Helping Hands, Giving Together, etc.). Reduced or Free Parking (depending on the geographic location) Puerto Rico associates are not eligible to earn PTO but they will earn Vacation and Sick Time 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 Affiliated with the CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico) IF Active RN license in FL, USA ,this is not a mandatory requirement Minimum 2 years prior clinical experience in an acute care, skilled nursing, rehabilitation , OR discharge planning Ability to work independently under general instructions and with a team Able to work within strict timeframes Able to work 8:30 AM - 5:30 PM (may be required to work weekends ) Role Desirables Health Plan experience Previous Case Management Experience Call center or triage experience Previous experience in discharge planning and/or home health or rehab 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. VSP associates with Humana work flexible hours to meet business needs, with no guaranteed minimum or maximum number of hours in any week. VSP associates are paid hourly and receive limited benefits. Benefits: Paid Time Off (PTO), Eligibility to participate in Humana's Partnership Savings Plan - Associates will be automatically enrolled in the 401K (accounts vest automatically on day one). Business Travel Accident Insurance. Associate Well-being Programs (WOW, EAP, Great Deals, Helping Hands, Giving Together, etc.). Reduced or Free Parking (depending on the geographic location) Puerto Rico associates are not eligible to earn PTO but they will earn Vacation and Sick Time SDL2017
Ciudad: san juan
