Acute Utilization Management Telephonic RN Remote North Central Region

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 acute care clinical experience (working in any of the following areas: Med Surg, Critical Care, ICU, ER, Ortho or Tele)

Comprehensive knowledge of Microsoft Word, Outlook and Excel

Excellent communication skills both verbal and written

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

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

Health Plan experience

Previous Medicare experience a plus

Milliman MCG experience preferred

Additional Information

Hours for this role are: Monday-Friday 8:30am-5:00pm CST or an Agile schedule 4x10 shift 7:00am-5:30pm CST with occasional weekend coverage

Scheduled Weekly Hours

40

Company info

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