SNF Utilization Management RN - Compact Rqd

Job Title

SNF Utilization Management RN - Compact Rqd

Humana

$71,100.00/yr - $97,800.00/yr

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 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The RN uses clinical knowledge, communication skills, and independent critical thinking skills toward interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.

Accounts for departmental, 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 while receiving guidance where needed. Follows established guidelines/procedures.

• Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action.
• MUST have Compact License.
• Greater than one year of clinical experience in an RN role in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc.
• Comprehensive knowledge of Microsoft Word, Outlook and Excel.
• Ability to work independently under general instructions and with a team.
• Passion for contributing to an organization focused on continuously improving consumer experiences.

• Education:
  
  BSN or Bachelor's degree in a related field.
• Three or more years of clinical experience in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc.
• Experience as an MDS Coordinator or discharge planner in an acute care setting.
• Previous experience in utilization management/utilization review for a health plan or acute care setting.
• Compact license PLUS a single state RN Licensure in any of the following non-compact states:
  California, Hawaii, Nevada, Oregon.
• Health Plan experience.
• Previous Medicare/Medicaid Experience a plus.
• Call center or triage experience.
• Bilingual is a plus.

• Scheduled Weekly
  
  Hours:
  
  40
• Travel:
  While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

• 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.

Humana offers competitive benefits that support whole-person well-being including medical, dental and vision benefits, 401(k) retirement savings plan, time off, disability, life insurance and many other opportunities.

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 also takes affirmative action in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.