Utilization Management Registered Nurse

Humana; Louisville (KY); Remote; USD 71,000 - 98,000; Full time

Job summary

Join a leading health services company as a Utilization Management Nurse 2, where you will utilize your clinical skills to coordinate medical services for Medicaid members. This role offers flexibility, with a schedule that includes weekends, and the chance to interact with healthcare providers and members in a supportive environment, all while working remotely in Kentucky.

Benefits

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Short-term and long-term disability insurance

Qualifications

• Minimum 1 year in-hospital Utilization Management experience.
• Minimum 2 years Progressive clinical experience in an acute hospital setting.
• Ability to work independently with minimal direction.

Responsibilities

• Coordinate and communicate with providers and members to facilitate care.
• Make decisions regarding own work methods in ambiguous situations.
• Follow established guidelines and procedures.

Skills

Clinical knowledge

Communication skills

Critical thinking

Proficiency with MS Office Suite

Education

Licensed Registered Nurse in Kentucky

Bachelor's Degree

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 for Humana’s Kentucky Medicaid Plan. 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 work both telephonically and onsite, interacting with providers and members, to determine appropriateness of services. The UM RN will use 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 Medicaid members.

Responsibilities for this position include:

• 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.

The schedule for this position will include weekends, typically Wednesday through Sunday from 8:00 AM to 5:00 PM Eastern Time with flexibility to adjust weekdays off with leader approval.

Use your skills to make an impact

Required Qualifications

• Licensed Registered Nurse (RN) in the stateof Kentuckywith no disciplinary action and ability to hold licenses in multiple states without restriction.

• Minimum 1 year in-hospital Utilization Management experience

• Minimum 2 years Progressive clinical experience in an acute hospital setting, skilled nursing or rehabilitation clinical setting

• Strong Proficiency with MS Office Suite to include Word, Excel, Power Point,to include quickly learn and navigate new systems and application as well as troubleshoot and resolve platform and connectivity issues

• Ability to work independently under general instructions and with a team

Preferred Qualifications

• Bachelor's Degree

• MCG experience

• 1+ year Care Management experience in an acute care, skilledor Rehabilitation clinical setting

• Certified Case Manager, CCM

• Health Plan experience

• Medicaid experience

• Bilingual in English and Spanish - Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages before placing on a dedicate line to service our members.

Additional Information

Workstyle: Remote work at home

Location: Must reside in Kentucky or a county that is within contiguous bordering states

Schedule: The schedule for this position will include weekends, typically Wednesday through Sunday from 8:00 AM to 5:00 PM Eastern Time with flexibility to adjust weekdays off with leader approval.

Travel: Travel to the Louisville office about 3-4 times annually.

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

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Employees 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 employees 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.

Interview Format part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [e-mail] with instructions on how to add the information into your official application on Humana’s secure website.

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
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.