Humana Case Management RN (FULLY Bilingual, Clinical exp a MUST) – San Juan in San Juan, Puerto Rico

  • Role: * RN Case Management –Spanish Speaking– San Juan Office *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

    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.

Title: Case Management RN (FULLY Bilingual, Clinical exp a MUST) – San Juan

Location: Puerto Rico-San Juan

Requisition ID: 179053