Utilization Management Nurse 2 Onsite - UK Medical

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

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

Prior clinical experience in an acute care setting

Ability to work independently under general instructions and with a team

Ability to research and problem solve independently

Strong listening and communication skills

Positive attitude and ability to adapt to change quickly

Proficient with Microsoft Office including Word, Excel and Outlook and Excel

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

This role is considered patient facing. If selected for this role, you will be required to be screened for TB

Preferred Qualifications

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

Previous Medicare Experience

Health Plan experience

Previous experience in utilization review

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required

Satellite and Wireless Internet service is NOT allowed for this role

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information

Work location: This role requires being onsite daily at UK Medical

Hours are: Monday-Friday 8:00am-5:00pm EST

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

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40

Company info

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