RN - Telephonic Utilization Review Nurse - Florida

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. Prior Authorization Review for Post acute level of care to include skilled nursing facility, acute rehabilitation and long term acute care facilities using Medicare and MCG guidelines.

Responsibilities

The Utilization Review Nurse (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

Licensed Registered Nurse (RN) in the state of Florida with no disciplinary action.

3 or more years of Medical Surgery, Heart, Lung or Critical Care Nursing experience

Previous experience in utilization management and/or case management.

Experience working with MCG or Interqual guidelines.

Comprehensive knowledge of Microsoft Word, Outlook and Excel.

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.

Must have a separate room with a locked door that can be used as a home office, to ensure you and your patients have absolute and continuous privacy while you work.

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.

Prior clinical experience preferably in an acute care clinical setting.

Health Plan experience

Previous Medicare/Medicaid Experience.

Additional Information

Work Schedule: 8 hours shift 8:30am - 5:00pm Monday - Friday

If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

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