Post-Acute Telephonic UM Nurse LPN or RN - Work at Home Mountain or Pacific Time Zones UT ID OR WA

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.The Utilization Management Nurse 2 will have respectful conversations and maintain curiosity around new ways of doing business and new opportunities to further support our members and our business unit needs. The Utilization Management Nurse 2 will understand that healthcare business continues past the end of a business day and may require additional hours worked on any given day, week, weekend, or holiday. The Utilization Management Nurse 2 will have solution-oriented thinking and will promote high quality work while improving processes to promote simplicity.

Responsibilities

The Telephonic 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

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

Required Qualifications

Active LPN or RN license in the state(s) in which the nurse is required to practice

At least 3-5 years of Post-Acute clinical experience in a Skilled Nursing Facility, IRF or LTAC

Must have good typing skills and proficiency using MS Office Word, Excel and Outlook

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

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

Mountain or Pacific Time zone residency

Preferred Qualifications

Education: BSN or Bachelor's degree in a related field

Health Plan experience

Previous Medicare experience a plus

Previous experience with MCG

Previous experience in utilization management or related activities reviewing criteria to ensure appropriateness of care, discharge planning and/or rehab

Scheduled Weekly Hours

40

Company info

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