Company name
Humana Inc.
Location
Glen Allen, VA, United States
Employment Type
Full-Time
Industry
Healthcare, Nursing
Posted on
Feb 08, 2021
Profile
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
Creating Healthy Communities is good for the Soul. Join Us! 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
Coordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning including to assist with social determinants and closing gaps
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
What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.
Required Qualifications
Licensed Registered Nurse (RN) in the state of Florida or compact license with no disciplinary action.
3 - 5 years of clinical experience in acute care setting required
Previous experience in utilization management required
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and with a team
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
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
3 or more 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 Experience a plus
Call center or triage experience
Bilingual is a plus
Additional Information
Work Schedule: 10 hours shift 7am - 5:30pm on Friday to Monday
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com