Humana

About Humana

 

Job Category:

Member Quality & Financials - Utilization Management

Country:

United States

Approximate Salary:

Not Specified

Position Type:

Full Time

Onsite Utilization Management Nurse - New Hanover, NC

Humana - Work At Home, North Carolina

Posted: 11/19/2018

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 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

This in an ONSITE position, working daily from a facility in New Hanover, NC. T

The hours are Mon-Fri, 8am-5pm est.

The Utilization Management Nurse 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. 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.

The Onsite UM Nurse will interact directly with members and act as a liaison with hospital staff to coordinate discharge planning.

               

Required Qualifications

  • RN license in NC without restrictions
  • This role is considered patient facing. If selected for this role, you will be required to be screened for TB.
  • Previous experience in utilization management required
  • Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
  • Strong computer skills and ability to easily navigate multiple programs
  • Ability to work independently under general instructions and with a team
  • Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

  • BSN or Bachelor's degree in a related field
  • Health Plan experience
  • Previous Medicare experience 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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