Utilization Management Nurse - Weekend Front End Review

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

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.


Required Qualifications


Licensed Registered Nurse (RN) in Florida with no disciplinary action.
3 or more years experience preferably in an acute care, skilled or rehabilitation clinical setting
4 X 10's Thursday- Sunday, 7am-6pm
Comprehensive knowledge of 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


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
Call center or triage experience
Bilingual


Additional Information


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


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.

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


Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/yammer and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

Scheduled Weekly Hours

40

Company info

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