DescriptionThe Utilization Management Nurse 2 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.
The Utilization Management Nurse 2 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.
- Licensed Registered Nurse (RN) in the state of Florida without restriction and ability to be licensed in multiple stated without restrictions.
- Must be willing to work Monday-Friday from 8:00AM-5:00PM within local time zone. In addition there will be rotating weekend and holidays. This will be discussed with the manager if selected for interview.
- 3-5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience required
- Prior clinical experience preferably in an acute care, clinical setting
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- Ability to work independently under general instructions and with a team
Additional Requirements based on location:
- This role may be considered patient facing. As part of part of Humana/Senior Bridge's Tuberculosis (TB) screening program, you will be required to be screened for TB if you are selected for the role.
- Must have a separate room for privacy with a locked door during working hours and during communication with members.
- 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
- Education: BSN or Bachelor's degree in a related field
- Previous experience in utilization management required
- Knowledge of MCG
- Health Plan experience
- Previous Medicaid Experience a plus
- Call center or triage experience
- Bilingual is a plus
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours40