RN Utilization Management

Choosegreaterpeoria; Orlando (FL); Remote; USD 71,000 - 98,000; Full time

Job summary

Join a caring community and become a Utilization Management Nurse 2 to support medical service coordination. This remote role requires clinical nursing skills to ensure optimal care for Medicare members. Ideal candidates should have a Florida RN license and at least two years of hospital experience. Enjoy a comprehensive benefits package and the opportunity to make a significant impact in healthcare.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off

Short-term and long-term disability

Life insurance

Qualifications

• Must have an active RN license in Florida.
• Experience in ICU, CCU, ER, and Med Surg required.
• Excellent computer skills with proficiency in MS Applications.

Responsibilities

• Coordinate case management for Medicare members.
• Communicate treatment options with providers and members.
• Interpret medical policies and determine appropriate actions.

Skills

Clinical nursing skills

Communication skills

Independent critical thinking

Computer skills

Education

Active Registered Nurse (RN) license

Minimum of 2 years clinical experience in hospital acute care

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft One Note

Job description

Become a part of our caring community and help us put health first

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.

This position is considered remote/work at home and may require 5% travel to market offices to support business needs. Work hours are Mon-Fri, 8am-5pm EST.

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.

This position will support CarePlus and will entail aspects of case management for discharge planning Medicare members from SNF/rehab facilities and will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.

Additional responsibilities include understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Make 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

Required Qualifications

• Active Registered Nurse (RN) license in, or including, the state of Florida with no disciplinary action.
• Must reside in Florida
• Minimum of 2 years clinical experience in hospital acute care experience with a broad background to include ICU, CCU, ER and Med Surg and/or a combination of skilled, rehabilitation, or long-term care.
• Excellent computer skills and ability to navigate easily using multiple applications
• Proficiency in Microsoft Word, Excel, Outlook and One Note
• Ability to travel 5% to market offices for business needs possible

Preferred Qualifications

• Utilization management and/or Case Management experience
• Health Plan experience
• Previous experience with Medicare/Medicaid criteria
• Experience with CMS guidelines

Remote 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

Screening

• Associate working in the State of Florida will need Completion of a Level II; AHCA background clearance Fingerprinting.

Additional Information:

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If participating in a SMS Text Screening, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. The duration is 5-10 minutes. Your responses will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$71,100 - $97,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.