Description
The 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.
Responsibilities
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.
Required Qualifications
Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
Minimum 3 years medical surgery, heart, lung, critical care, skilled or rehabilitation nursing experience
Intermediate or better working using Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and with a team
Additional Requirements / Adherence
Workstyle: Remote work at home
Location: U.S., Prefer Florida
Schedule:
40 hour work week Monday through Friday with flexibility to work 8 or 10 hour shifts upon leader approval.
Occasional weekend and holiday shifts
Travel: None
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA informatiion.
Preferred Qualifications
BSN or Bachelor’s degree in a related field
Previous experience in utilization management
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Bilingual is a plus
Additional Information
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
#L1-Remote
Scheduled Weekly Hours
40
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
On the Hook Fish and Chips is a growing company with a base of operations in northeast Denver. We are...
Apply For This JobResidential Pool Maintenance Technician Hours: Full Time or Part Time, Flexible Hours, Excellent Work/Life Balance! Signing Bonus: $250 after 90...
Apply For This JobPosition SummarySupervise operational activities which may include pit and/or plantproduction (secondary processing plant), plant maintenance, and mobileequipment in one of...
Apply For This JobTime Type: Full-time Travel Requirements: Up to 20% A career within Process Assurance services, will enable you to assist clients...
Apply For This JobWe are seeking an outgoing individual for our Remote Booking Agent position! You will be responsible for booking amazing trips...
Apply For This JobOverview This is an Associate position that reports into the Market/Capital Transaction Team Lead #1 and will work with other...
Apply For This Job