Location
Dover, DE, United States
Posted on
Mar 30, 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
Unrestricted Licensed Registered Nurse (RN) in a Compact (appropriate state) with no disciplinary action
Previous experience in Utilization Management
3 years clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Excellent computer skills and ability to navigate easily using multiple applications
Proficiency with MS Office Suite, Excel, Word, Outlook
Ability to work independently under general instructions and with a team
Additional Requirements
Hours: Monday - Friday 8 am- 5 pm local time with rotating on call and holiday coverage
Work style: This position is considered remote/work at home
Location: Remote - Work at home with Compact Nursing license
Remote Work at Home Requirements
Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet services NOT allowed for this role)
A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
Preferred Qualifications
Previous experience in Utilization Management
Education: BSN or Bachelor's degree in a related field
Health Plan experience
Bilingual is a plus
Interview Process
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
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 **** with instructions to add the information into the application at Humana's secure website
Scheduled Weekly Hours
40
Company info
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