Utilization Management Registered Nurse

Profile

Job Information

Humana

Utilization Management Registered Nurse

in

Louisville

Kentucky

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

Humana is seeking a dedicated, compassionate, and experience - Utilization Management RN

- who is interested in growing with the company and being part of something great!

Location

: This is a REMOTE - Work from Home

- position.

Humana is a Fortune 60 healthcare company with a history of successful innovation and reinvention, with over 50 years as a proven leader and innovator in the health and wellness industry. A passionate emphasis on people, choice, well-being, and innovation guide our business and culture. We're not just a health insurance company: our diverse lines of business position us to serve millions of people with a wide range of needs, including seniors, military members, and self-employed individuals.

Humana, a market leading Medicare Advantage and Medicare Prescription drug businesses, is continuing to grow with our continued investment in developing a robust integrated care delivery model that integrates insurance with high value health care services, such as Primary Care, Home Care, and Pharmacy. Humana is consistently recognized as a top place to work in healthcare, especially in areas of Diversity and Inclusion.

Vaccine Policy:

Humana, and its affiliates, encourages primary vaccination and an initial booster for forward-facing staff, except in cases of approved exceptions, in keeping with existing policy.

We recommend eligible team members receive COVID-19 boosters per CDC guidance (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html) , including the updated booster, with specific protection for Omicron variants, but vaccination is not a requirement of employment.

Masks are required regardless of vaccination status unless you are eating, drinking, or are working in an office alone.

Utilization Management RN Role Overview

Our team works along with the primary care physician's care team guiding the patient's care, to ensure we are able to facilitate any needed care for the patients. The UM Nurses in our program provide a vital connection between the patient's care coordination team and the required authorizations to facilitate their care. In addition to improving the patients experience along the continuum of care, our team is also helping to reduce the amount of waste spent in our health care system. Ideal candidates for the Utilization Management RN have a solid foundation of critical thinking skills and a high degree of emotional intelligence.

Utilize their clinical knowledge, communication skills, and critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for our patients

Provides a vital service that coordinates and communicates with providers, patients, or other health care providers to facilitate optimal care and treatment

Utilizes their clinical expertise to review clinical documentation alongside the required criteria to ensure we are guiding the patients to the right place at the right time

Frequent collaboration and support from the team as a whole.

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

At least 2 years of technical experience

Licensed Registered Nurse (RN) in the state in which you are practicing, with no disciplinary action

Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting

Comprehensive knowledge of Microsoft Word, Outlook and Excel

Preferred Qualifications

BSN or Bachelor's degree in a related field

Health Plan experience

Previous Medicare/Medicaid Experience a plus

Call center or triage experience

Bilingual is a plus

Ability to work independently under general instructions and with a team

Utilization Management RN Working hours:

Scheduled 40 hours per week

Monday to Friday 8AM-5PM

When travel is required; Cost and/or mileage is reimbursed

Being a part of the Humana team gives you benefits that include:

We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k with company matching, tuition reimbursement, weeks of paid vacation time, paid holidays, work-life balance, growth, a positive and fun culture and much more.

Alert:

Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Interview Format:

To enhance our hiring and decision-making ability. Modern Hire Text allows us to quickly connect and gain valuable information for 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 inviting you to participate in a Modern Hire text interview. In this interview, you will read to a set of interview questions and you will provide text responses to each question. You should anticipate this interview to take about 15 minutes. Your text interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Language Proficiency Testing:

Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. See Additional Information on testing. ​ Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Equal Employment Employer:

Humana is more than an equal opportunity employer, Humana's dedication to promoting diversity, multiculturalism, and inclusion is at the heart of what we do in all of our Humana roles. Diversity is more than a commitment to us, it is the foundation of what we do. We are fully focused on diversity of race, gender, sexual orientation, religion, ethnicity, national origin, veterans and all of the other fascinating characteristics that make us each uniquely wonderful.

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.

Company info

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