Utilization Management Nurse - Solutions - Compact RN

Become a part of our caring community and help us put health first

Full-Time, Remote Telephonic opportunity

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.

As a Utilization Management RN working on the One Home/Home Solutions UM Team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal  this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.

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

• 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.

• 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

• 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
• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and 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.

40

$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.

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.

Humana Inc. (NYSE: HUM) is committed to putting health…