Location
Meridian, ID, United States
Posted on
Jun 15, 2022
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.The Utilization Management Nurse 2 will have respectful conversations and maintain curiosity around new ways of doing business and new opportunities to further support our members and our business unit needs. The Utilization Management Nurse 2 will understand that healthcare business continues past the end of a business day and may require additional hours worked on any given day, week, weekend, or holiday. The Utilization Management Nurse 2 will have solution-oriented thinking and will promote high quality work while improving processes to promote simplicity.
Responsibilities
The Telephonic 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
Coordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning including to assist with social determinants and closing gaps
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
At least 3-5 years of Post-Acute clinical experience in a Skilled Nursing Facility, IRF or LTAC
Must have good typing skills and proficiency using MS Office Word, Excel and Outlook
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Ability to work independently under general instructions and with a team
Preferred Qualifications
Education: BSN or Bachelor's degree in a related field
Utilization management experience or related activities reviewing criteria to ensure appropriateness of care, discharge planning and/or rehab
Health Plan experience
Previous Medicare experience a plus
Milliman MCG experience preferred
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
Hours for this role are: Monday-Friday 8am-5pm
Must live within Mountain or Pacific Time Zone
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
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