Utilization Management Nurse 2 - Northeast Region

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

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 Licensed Registered Nurse (RN) with no disciplinary action (New York license is required)

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

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

Ability to work independently under general instructions and with a team

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

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

Health Plan experience

Previous experience in utilization management

Previous Medicare/Medicaid Experience a plus

Call center or triage experience

Previous experience with Milliman (MCG)

Discharge planning and/or home health or rehab

Additional Information

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

Scheduled Weekly Hours

40

Company info

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