Utilization Management Registered Nurse

Humana Inc; Montana; Remote; USD 71,000 - 98,000; Full time

Job summary

Humana Inc. is seeking a Utilization Management Registered Nurse to support healthcare coordination and documentation. This full-time remote position requires a licensed RN in Indiana with at least 3 years of relevant nursing experience. Join a leading company focused on improving member care and health outcomes.

Benefits

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Short-term and long-term disability

Life insurance

Qualifications

• 3+ years of nursing experience in relevant fields.
• Ability to work independently and in teams.
• Working knowledge of medical software and guidelines.

Responsibilities

• Utilizes clinical nursing skills to coordinate and communicate medical services.
• Makes independent decisions about work methods in cases of ambiguity.
• Follows established guidelines and procedures.

Skills

Communication skills

Critical thinking

Clinical knowledge

Education

Licensed Registered Nurse in the state of Indiana

Bachelor's degree

Tools

MS Office

Job description

Utilization Management Registered Nurse page is loaded

Utilization Management Registered Nurse

Apply locations Remote Indiana time type Full time posted on Posted 2 Days Ago job requisition id R-380091

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.

Use your skills to make an impact

Required Qualifications

• Must Reside in Indiana
• Licensed Registered Nurse in the state of Indiana without restrictions or disciplinary actions
• 3+ years of Medical Surgery, Heart, Lung, Emergency Room or Critical Care Nursing experience
• Working knowledge of MS Office including Word, Excel, PowerPoint, and Teams in a Windows based environment and an ability to quickly learn new systems and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
• Ability to work independently under general instructions and with a team.

Preferred Qualifications

• Bachelor's degree
• Previous experience in utilization management, case management, discharge planning and/or home health, rehab or behavioral health
• Managed Care / Health Plan experience
• Previous Medicare/Medicaid Experience
• Experience working with MCG or Interqual guidelines
• Working knowledge using the following systems/platforms CGX, MHK, Maccess, CAS
• Bilingual

Additional Information

Workstyle: Remote Work At Home

Training Schedule: Monday - Friday; 8:00am - 5:00pm EST

Schedule: Monday - Friday 8:00am - 5:00pm EST; overtime and weekends may be requested to meet business needs

Travel: Must be willing to commute about 5-10% to meet with providers or staff meetings. More information will be provided during the interview.

WAH Internet Statement

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
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.

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.