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.
Hours of operation: Monday-Friday 8 hour shifts between 8:00AM and 7:00 PM with the ability to work rotational weekends.
- Licensed Registered Nurse (RN) in the state of Florida with no disciplinary action.
- 2 years minimum prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- Ability to work independently under general instructions and with a team
- 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 prohibited). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload)
- This role is considered patient facing and is part of Humana/Senior Bridge's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
- Education: BSN or Bachelor's degree in a related field
- 3-5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
- Previous experience in utilization management/discharge planning
- Health Plan experience
- Previous Medicare/Medicaid Experience a plus
- Call center or triage experience
- Bilingual is a plus
Scheduled Weekly Hours40