Humana

About Humana

 

Job Category:

Member Quality & Financials - Utilization Management

Country:

United States

Approximate Salary:

Not Specified

Position Type:

Part Time

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RN Part time Front End Review - GA SC

Humana - Work At Home, Georgia

Posted: 11/11/2018

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

Training hours for this role are Mon-Fri 8am-5pm for 3-4 weeks and will then transition to the assigned part time hours of: Thursday/Friday 10hr shift 7am-6pm

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.

               

Required Qualifications

  • Active RN license without restrictions
  • Ability to be licensed in multiple states without restrictions  
  • Previous experience in an acute care setting
  • Familiar with process of reviewing cases for medical necessity
  • Excellent computer skills, specifically MS Excel & Word 
  • Strong communication and organization skills
  • Ability to work independently under general instructions and with a team
  • 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
  • Previous Medicare/Medicaid Experience a plus
  • 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

20

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