Humana

About Humana

 

Job Category:

Member Quality & Financials - Utilization Management

Country:

United States

Approximate Salary:

Not Specified

Position Type:

Full Time

Manager, Utilization Management Nursing - VA/NC/MD

Humana - Work At Home, Virginia

Posted: 11/19/2018

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

This role is based in the MidAtlantic region of VA, NC, MD, DC. The hours are Mon-Fri 8am-5pm est, with evening and weekend hours as needed.

There is a 4-6 week training plan, additional time may be needed/required depending on progress. Training is primarily virtual but 1-2 days in office and/or when new hires begin.

There is ongoing leadership trainings throughout the year—occasional travel may be required. 

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 RN with no restrictions
  • Minimum 1 year UM experience specifically
  • Minimum of 2 years of management experience
  • Advanced computer skills, able to easily learn and navigate multiple applications
  • Go above and beyond when needed; flexible and can pivot in a fast pace environment
  • 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 

Preferred Qualifications

  • Health Plan experience
  • Managed care experience

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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