Manager Utilization Management Nursing - Oklahoma

Profile

Description

The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The Manager, Utilization Management Nursing 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.

Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.

Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Required Qualifications

An active Registered Nurse (RN) licensed in the state of Oklahoma without restrictions.

Minimum two (2) years of leadership experience.

Progressive clinical experience preferably in an acute care, skilled or rehabilitation setting.

Previous experience in utilization management/utilization review.

Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.

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 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 a separate room with a locked door that can be used as a home office, to ensure you have absolute and continuous privacy while you work.

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.

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

Preferred Qualifications

BSN, Bachelor's degree in nursing, health services, healthcare administration, or business administration preferred.

Experienced with Milliman or Interqual criteria.

Additional Information

Benefits : Effective on the 1st day of employment; Medical, Dental & Vision, Competitive 401k match, Paid Time Off (PTO) accruals, Tuition Reimbursement, Parental Leave & much more.... .

Direct Reports: Up to 15 associates.

Typical Days/Ho urs : Monday - Friday; 8:00am - 5:00pm Central Standard Time (CST).

Travel: 25% in the state of Oklahoma to member's homes, facilities and/or business onsite meetings (Note: Business travel is suspended at this time due to business travel restrictions) .

Work location: Combination of office, field and remote. Ratio to be determined by leadership. Work location is temporary remote full-time - In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include: Access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, Dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, 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 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