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Utilization Management Nurse - (Humana)
Humana Full Time Nursing Remote-US
Remote Job 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.
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.
- Licensed Unrestricted Registered Nurse (RN) in the state of Florida
- Minimum 3 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience preferably in an acute care, skilled or rehabilitation clinical setting
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- 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
- This role is considered patient facing and is part of Humana/Senior Bridge's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
- 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 of 10x1 (10mbs download x 1mbs upload) is required
- 3+ years’ experience in a high volume community or mail order pharmacy practice environment
- Education: BSN or Bachelor's degree in a related field
- Health Plan experience
- Previous Medicare/Medicaid Experience a plus
- Previous experience in utilization management required
- Call center or triage experience
- Bilingual is a plus
- Interqual or Millman experience
As part of our hiring process for this opportunity, we will be using a technology called Modern Hire Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.
If you are selected for a phone screen you will receive an email inviting you to participate in a Modern Hire Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person video or telephonic interview.
Scheduled Weekly Hours
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