RN Utilization Management Nurse - Medicaid - Kentucky

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 for Humana's Kentucky Medicaid Plan. 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.

Hours: Typically an 8 hours shift Monday-Friday between 8:00 AM and 5:00 PM EST with rotating on-call coverage and oversight during weekends and holidays.

Primary Location: WAH Kentucky or in bordering counties of Kentucky (OH, IN)

Required Qualifications

Unrestricted Licensed Registered Nurse (RN) in the state of Kentucky with no disciplinary action and ability to hold licenses in multiple states without restriction.

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

Strong Proficiency with MS Office Suite to include Word, Excel, Power Point,

2 years Technical experience aptitude to troubleshoot and resolve system platform and connectivity problems

Ability to work independently under general instructions and with a team

Additional Requirements:

Hours: Typically an 8 hours shift Monday-Friday between 8:00 AM and 5:00 PM EST with rotating on-call coverage and oversight during weekends and holidays.

Primary Location: WAH Kentucky or in bordering counties of Kentucky (OH, IN)

Travel: This role may anticipate visiting onsite facilities depending on the supported region in addition to telephonic support. Travel may be required up to 3 days a week depending on location.

Transportation and Insurance Requirements: Valid driver's license, car insurance, and access to an automobile. This role is a 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.

Tuberculosis Screening: In the event that this role is requires facility visits or is patient facing within your region, you will be required to screen for TB as part of Humana's Tuberculosis (TB) screening program.

Work Style: This position is a combination office and remote/agile work based environment and will require the following:

Must ensure absolute and continuous privacy while you work within a home office or other remote location.

Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)

Preferred Qualifications

Bachelor's Degree

1 year Utilization Management experience

MCG experience

Health Plan experience

Medicaid experience

Ability to work in multiple states without restriction

Bilingual is a plus - Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages before placing on a dedicate line to service our members.

Additional Information:

Interview Format

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