RN Utilization Management Nurse 2

Humana; South Carolina; Remote; USD 71,000 - 98,000; Full time

Job summary

Join a caring community dedicated to putting health first as a Utilization Management Nurse. This role involves utilizing clinical nursing skills to coordinate and document medical services, ensuring optimal care for members. You will leverage your clinical knowledge and communication skills to make critical decisions while working independently and collaboratively. With a focus on health and well-being, this position offers a chance to make a real impact in the lives of individuals and families. If you are passionate about healthcare and eager to contribute to a supportive environment, this opportunity is perfect for you.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off

Short-term and long-term disability

Life insurance

Qualifications

• Utilization Management experience with Medicare and/or Medicaid guidelines.
• Ability to make independent decisions in ambiguous situations.

Responsibilities

• Coordinate and communicate with providers for optimal care.
• Interpret criteria and policies to provide appropriate treatment.

Skills

Clinical Nursing Skills

Communication Skills

Critical Thinking Skills

Computer Skills

Education

Active Florida license or Compact Registered Nurse Clinical license

2 years clinical experience

3 years experience in Utilization Management

Job description

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This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$71,100.00/yr - $97,800.00/yr

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.

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.
• This is a weekday position, the work schedule is Monday - Friday, 8:30am - 5:00pm Eastern Standard Time (EST).
  
  

Use Your Skills To Make An Impact

• Active Florida license or Compact Registered Nurse Clinical license without restrictions.
• A minimum of 2 years clinical experience in an acute care, skilled or rehabilitation clinical setting.
• A minimum of 3 years experience in Utilization Management with Medicare and/or Medicaid guidelines.
• Excellent computer and communication skills.
• Ability to work independently under general instructions and with a team.
  
  

Preferred Qualifications

• Health Plan experience
• MCG Certified
• Bilingual is a plus
  
  

Additional Information

This is a weekday position, the work schedule is Monday - Friday, 8:30am - 5:00pm Eastern Standard Time (EST).

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
  
  

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

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

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 year

This 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

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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