Become a part of our caring community and help us put health first
 

The Nurse Advice Line is a fast-paced inbound call center that provides Humana members with nursing advice and guidance. If you are looking for a remote position that offers variety and the opportunity to triage, assess, guide and/or educate while multi-tasking and supporting members with whatever they need, this could be a good fit for your next career move.

The hours for this position are Monday through Friday, 8-hour shifts -either 9:15AM to 5:45PM EST or 10:00AM to 6:30PM EST. Shift assignments will be determined based on operational needs at the discretion of department leadership.

The Telephonic Nurse provides medical guidance, assists with access to care concerns, screens for program referrals, provides information on the importance of preventive screenings or medication adherence and is trained to act as a clinical concierge.

The NAL Telephonic Nurse role is a remote position, with oversight from the NAL Manager; and they are expected to work independently with minimal supervision and meet productivity and quality targets such as Average Handle Time, Talk Time, documentation quality and compliance, etc. Responsibilities include:

• Provide accurate and appropriate medical advice and right level of care guidance utilizing approved medical resources.
• Utilize available resources to ensure members are aware of programs and services offered that may support their emotional and physical well-being.
• Ensure members are receiving preventative health care services, are compliant with all medications and assist with coordination of any/all needed care.
• Educate and assist member with plan education; offer support with managing network participation by using your knowledge of members benefit plan and Humana approved resources.
• Using established screening criteria to identify members for specific case management interventions as appropriate.
• Provide assistance to members experiencing access to care concerns.

Use your skills to make an impact
 

Required Qualifications

• Active Registered Nurse (R.N.) Multi-state/Compact State license with no disciplinary action.
• At least 3 years of clinical experience in an acute care, skilled or rehabilitation setting, home health, DME, triage, utilization, or case management.
• Ability to work ANY 8-hour shift Monday through Friday, between 9:15am to 6:30 pm Eastern Standard Time. Shift assignments will be determined based on operational needs at the discretion of department leadership.
• Ability to work independently, and within a team virtually
• Ability to meet productivity and quality expectations
• Ability to multi-task using multiple computer systems and platforms while talking and typing at the same time
• Proficient using MS Office (Word, Teams, OneNote and SharePoint) with ability to quickly learn and navigate new applications
• Ability to communicate effectively in both verbal and written format

Preferred Qualifications

• Bachelor’s degree in nursing (BSN)
• Previous case management, utilization review, or triage experience
• Previous experience in a call center
• Previous Medicare and/or Medicaid experience, including familiarity with CMS guidelines
• Strong Health plan operations experience
• Knowledge of Humana systems and clinical programs: CGX, CRM, SRO, Verint
• Bilingual – ability to speak fluently in both English and Spanish

Remote-Work-At-Home Requirements

To ensure Work-at-Home 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.
• Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Process

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 informatio