Onsite Acute Utilization Management Nurse - West Virginia University Hospital

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 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

Onsite Discharge Planning experience is required

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

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

Previous Medicare Experience

Health Plan experience

Previous experience in utilization review

Additional Information

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

This role is located onsite for part of the day at West Virginia University Hospital and the remainder of the day will be work at home. ( Currently this role is full time work at home all day due to COVID-19 and will remain so until it is considered safe for associates to be onsite at healthcare facilities once again )

Scheduled Weekly Hours

40

Company info

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