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.
- Bachelor's degree in Nursing/BSN
- Ideally 1- 5 years of relevant technical experience per job description
- Experience in acute inpatient care
- Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action.
- Ability to obtain other state licensures based on business needs
- 3-5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience required
- Previous experience in utilization management required
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- 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
- This will eventually be a WAH position (full-time) for Louisville KY area, however; first 3-6 months are mandatory in-office/business hours, at Waterfront Humana building.
- Ideal candidates will enjoy active participation/interactions daily, as part of a remote/virtual team
- Health Plan experience
- Previous Medicare/Medicaid Experience a plus
- Call center or triage experience
- Prior clinical experience in skilled nursing or rehabilitation clinical setting
- Interview Format
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.
This role is considered patient facing and is part of Humana’s Tuberculosis screening program. If selected for this role, you will be required to be screened for TB
At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.
Scheduled Weekly Hours40