[Hiring] Utilization Management Nurse @Humana

Role Description

The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures.
• Provides 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 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.

Qualifications

• Licensed Registered Nurse (RN) (Compaq License) with no disciplinary action.
• Bachelor's degree.
• 3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience.
• Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
• Comprehensive knowledge of Microsoft Word, Outlook and Excel.
• Ability to work independently under general instructions and with a team.

Requirements

• MCG/InterQual experience.
• Previous experience in utilization management.
• Health Plan experience.
• Previous Medicare/Medicaid experience.
• Call center or triage experience.

Benefits

• Competitive benefits that support whole-person well-being.
• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.

Additional Information

• Remote to work the eastern or central time zone.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• This position is subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse.
• Scheduled Weekly Hours: 40.
• Pay Range: $71,100 - $97,800 per year.
• This job is eligible for a bonus incentive plan based upon company and/or individual performance.