RN - Telephonic Utilization Management Nurse - Remote Mountain or Pacific Time Zones

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 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.

Ideal candidate

The ideal candidate for this position will live within the Mountain or Pacific Time zones, have an active and unrestricted RN license and a background working in utilization management strongly preferred. The ideal candidate will be able to obtain RN licensure in the states of Utah, Idaho, Washington, Montana, Oregon, Alaska and Wyoming upon hire.

The Utilization Management Nurse 2 will have respectful conversations and maintain curiosity around new ways of doing business and new opportunities to further support our members and our business unit needs. The ideal candidate will understand that healthcare business continues past the end of a business day and may require additional hours worked on any given day, week, weekend, or holiday. The ideal candidate will have solution-oriented thinking and will promote high quality work while improving processes to promote simplicity.

Required Qualifications

Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action

Must have the ability to be licensed in multiple states

3-5 years of Medical/Surgical or equivalent nursing experience in acute care required

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

Preferred Qualifications

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

Utilization management experience or related activities reviewing criteria to ensure appropriateness of care, discharge planning and/or rehab is strongly preferred

Health Plan experience

Previous Medicare experience a plus

Milliman MCG experience preferred

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 Pacific Time

Must live within Mountain or Pacific Time Zone

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