Weekend Utilization Management Front End Review Registered Nurse

Profile

Description

Utilization Management Nurse - Weekend Front End Review 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.

4 X 10's Thursday- Sunday, 7am-6pm

How we Value You

Shift Differential!

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Responsibilities

The Utilization Management Nurse - Weekend Front End Review 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.

Utilize MCG criteria to perform acute concurrent front end reviews on Humana members to determine medical necessity.

Must be willing to compy with the following:

Florida RN license or Compact License without disciplinary action

Availability to work a Weekend Schedule every weekend. With a schedule of Saturday-Tuesday each week.

4 X 10's Sunday, Monday, Tuesday, Saturday 7:00 AM to 6:00 PM

Required Qualifications

Licensed Registered Nurse (RN) in Florida license or compact license with no disciplinary action.

3 or more years experience preferably in an acute care- inpatient hospital setting.

Intermediate or better working using 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

Strong general computer skills in an autonomous work setting.

Additional Requirements/Adherence

Workstyle: Remote Work at Home

Location: Florida or Central or Eastern Time Zone - Will be supporting the Florida market

Hours:

Availability to work a Weekend Schedule every weekend. With a schedule of Saturday-Tuesday each week.

4 X 10's Sunday, Monday, Tuesday, Saturday 7:00 AM to 6:00 PM

Travel: None

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA informatiion.

Preferred Qualifications

Bachelor's degree

Front End Review experience

Previous experience in Utilization Management

CGX experience

MCG experience

Health Plan experience

Previous Medicare/Medicaid Experience

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 or computer 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

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

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