Humana
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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. Creating Healthy Communities is good for the Soul. Join Us! 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.
Required Qualifications: Licensed Registered Nurse (RN) with compact license with no disciplinary action or in process of obtaining compact license 3 - 5 years of Clinical Nursing experience required; preferably Emergency room or critical care Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting Comprehensive knowledge of Microsoft Word, Outlook and Excel 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. Must be passionate about contributing to an organization focused on continuously improving consumer experiences. Preferred Qualifications: Education: BSN or Bachelor's degree in a related field Health Plan experience Experience in utilization management or related activities reviewing criteria to ensure appropriateness of care preferred Previous Medicare experience a plus Milliman MCG experience preferred Work-At-Home Requirements: To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment Coordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning including to assist with social determinants and closing gaps 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
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Basic
Telehealth
$34
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ATS optimized design for nurses
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ADVANCED
Telehealth
$79
Everything from Starter Pack
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BEST VALUE
Telehealth
$149
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Career Accelerator Success Guide
Proven method for landing your dream role
Lifetime Premium Job Board Access
Application Tracker
1:1 Expert Support
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