Onsite Acute Utilization Management Nurse Baptist Health Lexington

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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

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

3-5 years of prior clinical experience in an acute care setting

Ability to work independently under general instructions and with a team

Ability to research and problem solve independently

Strong listening and communication skills

Positive attitude and ability to adapt to change quickly

Proficient with Microsoft Office including Word, Excel and Outlook and Excel

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

This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB

Preferred Qualifications

Education: BSN or Bachelor’s degree in a related field

Previous Medicare Experience

Health Plan experience

Previous experience in utilization review

Prior case management experience

Additional Information

Work location: This role requires being onsite daily at Baptist Health located in Lexington, KY

Hours are: Monday-Friday 8:00am-5:00pm

Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

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Company info

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