Acute Utilization Management Nurse - Remote KY or PA

Profile

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

Creating Healthy Communities is good for the Soul. Join Us! 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

Coordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning including to assist with social determinants and closing gaps

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 in the state(s) in which the nurse is required to practice

Prior acute care clinical experience (1-3 years of experience working in any of the following areas: ER, Critical Care, ICU, Ortho, Med Surg, Tele, CM, or Home Health)

Must have good typing skills and proficiency using MS Office Word, Excel and Outlook

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Ability to work independently under general instructions and with a team

Preferred Qualifications

Education: Bachelor's degree in nursing

Health Plan experience

Previous Medicare experience a plus

Previous experience with MCG

Previous experience in utilization management or related activities reviewing criteria to ensure appropriateness of care

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required

Satellite and Wireless Internet service is NOT allowed for this role

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information

Hours for this role are: Monday-Friday 8am-5pm EST

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com