DescriptionThe 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.
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.
The ideal candidate for this position will be an RN with prior acute UM process experience; have experience leading teams; will be flexible, adaptable, dedicated to the position, their staff and our members; comfortable mentoring, coaching and providing disciplinary actions when needed. The position is Monday through Friday, 8 to 5 Central Time.
- Bachelor's Degree or equivalent
- 6+ years of varied clinical nursing experience
- 2+ years of management experience
- Licensed Registered Nurse (RN) in Texas with no restrictions
- Prior Medicare / Medicaid experience
- Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Ability to work independently under general instructions and with a team
- Valid drivers license and/or dependable transportation necessary (variable by region)
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance for Humana systems is 10Mx1M
- Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.
- Prior supervisory experience leading teams
- Prior experience working from home
- Health Plan experience
- Bilingual is a plus
Scheduled Weekly Hours40