Manager Utilization Management RN - Remote

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Job Information

Humana

Manager, Utilization Management RN - Remote

in

Troy

Michigan

Description

The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

Humana is seeking a dedicated, compassionate, and experience - Utilization Management RN Manager

- who is interested in growing with the company and being part of something great!

Location

: This is a REMOTE - Work from Home

- position.

Humana is a Fortune 60 healthcare company with a history of successful innovation and reinvention, with over 50 years as a proven leader and innovator in the health and wellness industry. A passionate emphasis on people, choice, well-being, and innovation guide our business and culture. We're not just a health insurance company: our diverse lines of business position us to serve millions of people with a wide range of needs, including seniors, military members, and self-employed individuals.

Humana, a market leading Medicare Advantage and Medicare Prescription drug businesses, is continuing to grow with our continued investment in developing a robust integrated care delivery model that integrates insurance with high value health care services, such as Primary Care, Home Care, and Pharmacy. Humana is consistently recognized as a top place to work in healthcare, especially in areas of Diversity and Inclusion.

Vaccine Policy:

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination OR

Commit to weekly testing, following all CDC protocols, OR

Provide documentation for a medical or religious exemption consideration.

This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

Utilization Management RN Manager Role Overview

This leader should have a strong foundation in Utilization Management, ideally focused on the Medicare and/or Medicaid populations. Our UM model incorporates the patient's primary care physician back into the decision making for the patients, allowing our nurses additional opportunity to advocate for the patients throughout their care continuum. Experience working within a Value Base Care model is preferred.

Utilizing clinical skills to support the coordination, documentation and communication within specific guidelines and procedures is a must.

In addition to the oversight of their team this associate will play a key role in relationship development with the provider organizations we currently support. Develop and maintain cross departmental collaboration

Conducts briefings and area meetings

Maintains frequent contact with other leaders both internal and external partners.

Allowing the opportunity to for this leader to facilitate changes that will help us continue to evolve the ways we can support our patients and clinicians.

Required Qualifications

6 years of technical experience

2 years of utilization management experience

Licensed Registered Nurse (RN) in the state in which you reside, with no disciplinary action

Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting

2 years of experience leading a team of clinicians

Ability to navigate change management in a rapidly evolving Utilization Management program

Preferred Qualifications

Previous experience working in a Value Based Care Model

Care coordination experience

Health Plan experience

Prior Medicare / Medicaid experience

Call center or triage experience

Bilingual is a plus

Utilization Management RN Manager Working hours:

Scheduled 40 hours per week

Monday to Friday 8AM-5PM

When travel is required; Cost and/or mileage is reimbursed

Being a part of the Humana team gives you benefits that include:

We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k with company matching, tuition reimbursement, weeks of paid vacation time, paid holidays, work-life balance, growth, a positive and fun culture and much more.

Alert:

Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Interview Format:

To enhance our hiring and decision-making ability. Modern Hire Text allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire text interview. In this interview, you will read to a set of interview questions and you will provide text responses to each question. You should anticipate this interview to take about 15 minutes. Your text interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Language Proficiency Testing:

Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. See Additional Information on testing. ​ Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Equal Employment Employer:

Humana is more than an equal opportunity employer, Humana's dedication to promoting diversity, multiculturalism, and inclusion is at the heart of what we do in all of our Humana roles. Diversity is more than a commitment to us, it is the foundation of what we do. We are fully focused on diversity of race, gender, sexual orientation, religion, ethnicity, national origin, veterans and all of the other fascinating characteristics that make us each uniquely wonderful.

Scheduled Weekly Hours

40

Company info

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