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Humana Utilization Management Nurse 2 (Remote) Gulf States Region in Metairie, Louisiana

Description

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.

Responsibilities

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.

Required Qualifications

  • Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action

  • 3-5 years of prior clinical experience preferably in an acute care hospital, skilled or rehabilitation clinical setting

  • Comprehensive knowledge of Microsoft Word, Outlook and Excel

  • Excellent communication skills both verbal and written

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

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

Preferred Qualifications

  • Education: BSN or Bachelor's degree in a related field

  • Experience in utilization management is strongly preferred or related activities reviewing criteria to ensure appropriateness of care

  • Previous Medicare experience a plus

  • Milliman MCG experience preferred

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

Additional Information

  • Hours for this role are: Monday-Friday 8am-5pm CST

Scheduled Weekly Hours

40

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