RN Utilization Management Nurse 2 - Southeast Region Work at Home

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.

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

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

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

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

Preferred Qualifications

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

Health Plan experience

Experience in utilization management or related activities reviewing criteria to ensure appropriateness of care preferred

Previous Medicare/Medicaid experience a plus

Milliman MCG experience preferred

Call center or triage experience

Bilingual is a plus

Additional Information

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

Scheduled Weekly Hours

40

Company info

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