Utilization Management RN - Physical Health

Humana

4d • Remote

About The Position

Become a part of our caring community and help us put health first Why Humana? At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we've got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future. Fostering a culture of inclusion is part of the fabric of who we are. We must have a workplace that reflects the people we serve and thrives in part because every person can bring their whole self to work to make an impact. Our vibrant, diverse culture and environment of inclusion is one of our greatest strengths. About Humana Healthy Horizons Humana Healthy Horizons is more than a health plan. We're human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health. The Utilization Management (UM) Nurse 2 uses clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. The Utilization Management Nurse 2's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Requirements

• Must Reside in Oklahoma
• An active Licensed Registered Nurse (RN), unrestricted
• 3+ years of prior clinical experience, preferably in an acute care, skilled or rehabilitation clinical setting
• Comprehensive knowledge of Microsoft Excel and Outlook
• Ability to work a weekend rotation

Nice To Haves

• Previous experience in Utilization Management
• Prior experience with EPIC Programs
• Previous remote work experience

Responsibilities

• Uses clinical knowledge toward interpreting criteria and procedures to provide the best and most appropriate treatment, care, or services for Enrollees
• Coordinates and communicates with Providers, Enrollees or other parties to facilitate optimal care and treatment
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
• Uses judgement regarding own work methods, occasionally in ambiguous situation, and receiving guidance where needed
• Follows established guidelines and procedures
• Periodic travel to Humana Oklahoma City office for meetings and training

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed