Utilization Management Registered Nurse - Home Health

004 Humana Insurance Company; Kentucky; Híbrido; USD 71.000 - 98.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Short-term and long-term disability

Life insurance

Descripción de la vacante

Humana, Inc. is seeking an Utilization Management Nurse 2 to coordinate, document, and communicate medical services and benefit determinations for our members.

You will interpret clinical information to support recommendations and care coordination, and collaborate with internal and external parties to ensure fully coordinated care for each member. This is a remote role with standard business hours and occasional travel for training.

Formación

• Minimum of Associate Degree in nursing and active RN license in a compact state.
• Three or more years of progressive clinical experience including direct patient care.
• Strong telephonic and virtual communication skills; ability to navigate multiple systems.
• Ability to work independently under general instructions and within a team.
• Preferred experience in home health or utilization management.

Responsabilidades

• Coordinate, document, and communicate medical services and benefit determinations.
• Interpret clinical information to support recommendations and care coordination.
• Collaborate with internal and external parties to ensure fully coordinated care for members.
• Utilize multiple systems to manage cases and maintain PHI/HIPAA compliance.

Conocimientos

Nursing clinical skills

Analytical skills

Telephonic communication

Virtual communication

Independent judgment

Collaboration

Time management

Educación

Associate Degree in Nursing

RN licensure in compact state

Bachelor’s degree preferred

Herramientas

Microsoft Word

Outlook

Excel

Descripción del empleo

Become a part of our caring community

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 helps to ensure fully coordinated care at home for our members.

Success in this role requires the following:

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.


• Excellent organizational and time management skills


• Solid analytical skills to understand and interpret clinical information to make recommendations to improve patient outcomes.


• Technical savvy and ability to navigate multiple systems and screens while working cases.


• Collaboration skills to effectively interact with multiple parties both internal and external.


• An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.


• Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed.


• Ability to follow established guidelines, processes, and procedures.

Shift is Monday - Friday 8:00am - 5:00pm Eastern Standard Time

Required Qualifications

• Minimum of Associate Degree in nursing


• Licensed Registered Nurse (RN) in a compact state with no disciplinary action.


• Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.


• Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population


• Effective telephonic and virtual communication skills


• Comprehensive knowledge of Microsoft Word, Outlook and Excel


• Ability to work independently under general instructions and within a team.

Preferred Qualifications

• Bachelor’s degree


• Two (2) or more years of home health experience and/or utilization management experience


• Experience in a managed care setting


• Health Plan experience


• CGX experience

Work-At-Home Requirements

• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).


• A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.


• Check your internet speed at www.speedtest.net.


• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.


• 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: 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.


• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.


• 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.

Florida Background Screening Requirements

Notice for candidates applying to this position from a Florida work location, including Florida home-based work location. This position is subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse. For information about the screening process and requirements, visit https://info.flclearinghouse.com.

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

• 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Learn more about what we offer at Humana.com and at CenterWell.com.

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and 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.