RN Utilization Management Nurse Louisville KY

Profile

Description

Humana Healthy Horizons in Kentucky is seeking a Utilization Management Nurse 2 who will utilize their clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. 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 the state of Kentucky with no disciplinary action.

Minimum of two (2) years of progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.

Must reside in the Louisville, KY or surrounding counties.

Strong Proficiency with MS Office Suite specifically in Outlook, Word and Excel.

Basic computer technical knowledge and/or experience to troubleshoot and resolve system platform and connectivity problems.

Ability to work independently under general instructions and with a team.

This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

This role is a part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Must have the ability to provide a high speed DSL or cable modem for a home office.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Preferred Qualifications

Bachelor's Degree.

Minimum of one (1) year of Utilization Management experience.

MCG experience.

Health Plan experience.

Medicaid experience.

Bilingual is a plus - Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages before placing on a dedicate line to service our members.

Additional Information

Workstyle: Remote with travel (see Travel).

Work Schedule : Typically an 8 hour shift Monday-Friday between 8:00 AM and 6:00 PM EST with rotating on-call coverage and oversight during weekends and holidays.

Travel: This role may anticipate visiting onsite facilities in Louisville, KY. Travel may be required up to 3 days a week depending on hospital location.

Interview Format

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.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com