RN - -Telephonic Utilization Management Nurse - Work at Home Mountain or Pacific Time Zones

Profile

Description

The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.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 Utilization Management Nurse 2 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 Utilization Management Nurse 2 will have solution-oriented thinking and will promote high quality work while improving processes to promote simplicity.

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. The ideal candidate will be able to obtain RN licensure in the states of Utah, Idaho, Washington, Montana and Oregon 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

Active and unrestricted registered nursing license with the ability to obtain licensure in all states covered

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

Utilization management experience which includes following MCG/Milliman or Interqual guidelines

Proficient with Microsoft Office products including 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

Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.

Live within the Mountain or Pacific Time zones

Preferred Qualifications

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

Health Plan experience

Previous Medicare experience a plus

Previous experience with MCG

Previous experience in utilization management or related activities reviewing criteria to ensure appropriateness of care, discharge planning and/or rehab

Additional Information

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

Must live within Mountain or Pacific Time Zone

Scheduled Weekly Hours

40

Company info

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