Remote Utilization Management Review RN-SNF experience at Humana

About the position

Become a part of our caring community and help us put health first. The Utilization Management Registered 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 Registered 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. Use your skills to make an impact.

Responsibilities
• Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
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• Interpret criteria, policies, and procedures to provide appropriate treatment, care, or services for members.
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• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
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• Make independent decisions regarding work methods in ambiguous situations with minimal direction.
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• Follow established guidelines and procedures.

Requirements
• Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action.
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• Must have Compact License.
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• 3+ years of Skilled Nursing Facility experience.
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• Previous experience in utilization management required.
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• Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
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• Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
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• Ability to work independently under general instructions and with a team.
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• Must have the ability to provide a high-speed DSL or cable modem for a home office.

Nice-to-haves
• BSN or Bachelor's degree in a related field.
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• Health Plan experience.
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• Previous Medicare/Medicaid Experience a plus.
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• Call center or triage experience.
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• Bilingual is a plus.

Benefits
• Medical, dental, and vision benefits.
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• 401(k) retirement savings plan.
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• Paid time off, including company and personal holidays.
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• Volunteer time off.
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• Paid parental and caregiver leave.
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• Short-term and long-term disability.
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• Life insurance.

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