Humana

About Humana

 

Job Category:

Member Quality & Financials - Utilization Management

Country:

United States

Approximate Salary:

Not Specified

Position Type:

Full Time

Manager, Utilization Management - N. Broward County, FL

Humana - Work At Home, Florida

Posted: 09/5/2018

Description

The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

  • The hours of this role are Mon-Fri, 8am-5pm est.

    This role is based from a home office and requires 50% travel to SNFs in the Treasure Coast area

    The Manager, Utilization Management Nursing 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. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

               

Required Qualifications

  • Licensed Registered Nurse (RN) in FL with no disciplinary action
  • Utilization management experience in a hospital or SNF setting
  • Progressive clinical experience in an acute care, skilled or rehabilitation clinical setting
  • Ability to work independently under general instructions and with a team
  • Experience as a Supervisor, Preceptor or SME
  • Excellent computer skills and ability to easily navigate multiple applications

  • Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M

  • TB screen required if selected

Preferred Qualifications

  • Prior supervisory experience highly preferred 
  • Health Plan experience
  • Prior Medicare / Medicaid experience
  • Call center or triage experience
  • Bilingual is a plus

Additional Information

As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.

 

If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.

Scheduled Weekly Hours

40

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