RN Utilization Management - Onsite in Miami- Dade County - travel required

Profile

Description

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services, discharges 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 at an on-site facility.

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 our Medicare members.

Coordinate and communicate with providers, members, case managers PCP or other parties to facilitate appropriate discharge planning, assist with social determinants and closing gaps to facilitate optimal care and treatment

Identify barriers to discharge and unavoidable readmissions

Understands department, segment, and organizational strategy and operating objectives, including how they interrelate to each area

Works independently, makes appropriate decisions, requires minimal direction and seeks guidance where needed

Evaluate and refer to other programs available to Member

Follows established guidelines/procedures

Required Qualifications

RN License without restrictions in Fl or Compact State license.

Located near Miami-Dade hospitals and facilities including Jackson North Medical Center.

2 or more years of 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

Independent critical thinking skills

Strong Written and verbal communication skills

Valid Driver's License and/or dependable transportation necessary

Travel to Hospital/Provider for on-site reviews to assist Members

This role is considered patient facing. If selected for this role, you will be required to meet criteria to be on-site with Providers/Hospitals/Health Care Facilities including Flu vaccine, Covid Vaccine, TB Test, Immunizations (Hep B, MMR, Varicella). Level 1 and 2 background.

Preferred Qualifications

BSN or Bachelor's degree in a related field

Previous experience in discharge planning, utilization management or case management a plus

Health Plan experience

Previous Medicare Experience a plus

Bilingual is a plus

Additional Information:

This position supports the Florida Region Medicare Health Service Organization

Must be able to work 8:30 am-5pm EST M-F

85-90% onsite and the remaining time is remote/WAH.

Scheduled Weekly Hours

40

Additional Information

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

As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.

If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

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