The Clinical Access Grievance Team Nurse uses clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members.
Responsibilities will include the following:
Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
Facilitates verified eligible Humana benefits to a provider and/or member while effectively documenting through assessments and/or evaluations and maintaining compliance with CMS regulations.
Assess for member physical, environmental, and psycho-social health issues and intervene appropriately.
Employs a variety of strategies, approaches and techniques to assess, intervene, and resolve Access to Care (ATC) barriers related to immediate medical services.
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
Follows established guidelines/procedures
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Required Qualifications
Associate’s degree
Licensed Registered Nurse (RN) in the (appropriate Compact state) with no disciplinary action
Candidates must have a valid Compact license in the state where they reside. Candidates must reside in a Compact state excluding AK, CA, DC (District of Columbia), HI, IL, MA, MI, MN, NV, NY, and OR.
3 years or more of clinical acute care experience
Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook
Preferred Qualifications
Bachelor’s degree (BSN)
Experience with case management, discharge planning and patient education for adult acute care
Managed care experience
Certified Case Manager (CCM)
Additional Information
Work schedule will be 10:00am-6:30pm EST.
Associate will be expected to participate in weekend rotation a minimum of once every 14 weeks (one hour each on Saturdays and Sundays).
Interviewing Technology:
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Work At Home / Internet Information:
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
SSN Alert: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.