Utilization Management Nurse 2 - Travel Aguadilla thru Caguas PR

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

Bachelor's degree - BSN

Licensed Registered Nurse (RN) in Puerto Rico with no disciplinary action.

1 year of Prior 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

Preferred Qualifications

Health Plan experience

Previous experience in utilization management

Previous Medicare/Medicaid Experience

Call center or triage experience

2-3 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience

Bilingual English/Spanish. Candidate selected will not be communicating in English with members

Additional Information

Schedule: Monday thru Friday 8:30am - 5:30pm. Overtime if needed. No weekends

Training: 6 months. Office/Field (hospitals)

Address: Associates work from non-Humana locations (Hospitals) Travel in territories from Aguadilla thru Caguas, PR

Travel: Aguadilla thru Caguas, PR. Mileage reimbursement

Work Style: Field. Associates work from non-Humana locations (such as provider facilities, Hospitals)

Scheduled Weekly Hours

40

Company info

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