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.
Success in this role requires:
- Passion for contributing to an organization focused on continuously improving consumer experiences
- Excellent organizational and time management skills
- Solid analytical skills to understand and interpret clinical information to make recommendations to improve patient outcomes
- Technical savvy and ability to navigate multiple systems and screens while working cases
- Collaboration skills to effectively interact with multiple parties both internal and external
- Understanding of department, segment, and organizational strategy and operating objectives
- Ability to make decisions regarding own work methods, occasionally in ambiguous situations, and with minimal direction
- Ability to follow established guidelines, processes, and procedures
Required Qualifications:
- Minimum of Associate Degree in nursing
- Licensed Registered Nurse (RN) in a compact state with no disciplinary action
- Valid compact license or reside in a compact state and be eligible to upgrade to compact licensure
- Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population
- Effective telephonic and virtual communication skills
- Comprehensive knowledge of Microsoft Word, Outlook, and Excel
- Ability to work independently under general instructions and within a team
Preferred Qualifications:
- Bachelor’s degree
- Two (2) or more years of home health experience and/or utilization management experience
- Experience in a managed care setting
- Health Plan experience
- CGX experience
Work-At-Home Requirements:
- High-speed DSL or cable modem for a home office
- Minimum standard speed for optimal performance is 25mbs download x 10mbs upload
- Dedicated office space lacking ongoing interruptions
Scheduled Weekly Hours: 40
Pay Range: $71,100 - $97,800 per year
Description of Benefits: Humana offers competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, short-term and long-term disability, life insurance, and more.
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