Onsite Acute Utilization Management Nurse - OSF Saint Francis Peoria IL

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

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

3-5 years of clinical experience in an acute care hospital clinical setting

Case Management experience is required

Comprehensive knowledge of Microsoft Office, Word, Outlook and Excel

Excellent communication skills both verbal and written

Positive attitude and ability to adapt to change quickly

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

This role is considered patient facing and is part of Humana/Senior Bridge's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB

Preferred Qualifications

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

Previous experience in utilization management

Milliman MCG guidelines experience

Health Plan experience

Previous Medicare/Medicaid experience a plus

Home Health experience

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 CST

This role is located onsite for part of the day at OSF Saint Francis, Peoria, IL and the remainder of the day will be work at home

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