Utilization Management LTSS Registered Nurse

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 (UM) Nurse 2 RN utilizes clinical nursing skills to support the coordination, documentation and communication of long-term supports and services and/or benefit administration determinations. The UM Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The UM Nurse 2 work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors

Uses clinical knowledge, communication skills, and independent critical thinking skills towards. Interpreting criteria, policies, and procedures related to Long Term Services and Support authorizations 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 and organizational strategy and operating objectives, including their linkages to related areas. Follows established guidelines/procedures. Makes decisions regarding own work methods, occasionally in ambiguous situations, requires minimal direction and receives guidance where needed.