RN - Utilization Management Nurse 2 Must reside in Mesa or Phoenix AZ area

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Job Information

Humana

RN - Utilization Management Nurse 2 (Must reside in Mesa or Phoenix, AZ area)

in

Phoenix

Arizona

Description

The Utilization Management Field Nursing Professional 2 utilizes clinical nursing skills in the field to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Field Nursing Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Utilization Management Field Nursing Professional 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

Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action

3-5 years of prior clinical experience preferably in an acute care hospital, skilled or rehabilitation clinical setting

Comprehensive knowledge of Microsoft Word, Outlook and Excel

Ability to work independently under general instructions and with a team

Ability to thrive in a changing work environment

Excellent communication skills both verbal and written

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

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

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

We will require   full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html#vaccinated)

for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve

If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law

Preferred Qualifications

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

Previous experience in utilization management

Milliman MCG guidelines experience

Health Plan experience

Previous Medicare/Medicaid experience a plus

Bilingual is a plus

Additional Information

Hours for this role are: Monday-Friday 8am-5pm PST

This role is located onsite for 2-3 days for required onsite visits and the rest of the time would be work at home. This role will service one of the following hospitals located in Mesa, AZ (Banner Desert, Banner Baywood or Banner Heart)

Currently this role is full time work at home all day due to COVID-19 and will remain so until it is considered safe for associates to be onsite at healthcare facilities once again

Candidates must live within close proximity to major hospitals in the Mesa or Phoenix, AZ areas

Scheduled Weekly Hours

40

Company info

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