Company name
Humana Inc.
Location
Fargo, ND, United States
Employment Type
Full-Time
Industry
Healthcare, Nursing
Posted on
Feb 16, 2022
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 prior acute care clinical experience (working in any of the following areas: Med Surg, Critical Care, ICU, ER, Ortho or Tele)
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Excellent communication skills both verbal and written
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
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
Experience in utilization management is strongly preferred or related activities reviewing criteria to ensure appropriateness of care
Health Plan experience
Previous Medicare experience a plus
Milliman MCG experience preferred
Additional Information
Hours for this role are: Monday-Friday 8:30am-5:00pm CST or an Agile schedule 4x10 shift 7:00am-5:30pm CST with occasional weekend coverage
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com