Utilization Management Nurse

Humana

3d • $65,000 - $88,600 • Remote

About The Position

Become a part of our caring community and help us put health first The Utilization Management Nurse 1 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 1 work assignments are often straightforward and of moderate complexity. The Utilization Management Nurse 1 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Use your skills to make an impact

Requirements

• Licensed Registered Nurse (RN) in the state of Indiana with no disciplinary action
• Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
• Ability to work independently under general instructions and with a team
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Associates 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Nice To Haves

• Bachelor's degree
• Health Plan experience
• Previous Medicare/Medicaid Experience a plus
• Call center or triage experience
• Previous experience in utilization management, discharge planning and/or home health or rehab
• LTSS knowledge and experience
• Bilingual is a plus

Responsibilities

• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level