The Manager, Utilization Management Nursing utilizes clinical and leadership skills to support the coordination, documentation and communication of home health authorizations. This leader works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. #Remote-LI
This is a remote job opportunity. We value associate engagement & your well-being. We provide excellent professional leadership development & continued education.
Responsibilities
The Manager of UM Nursing uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting home health criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for our members. As a leader, they guide the UM Nurse and UM Administration Coordinator teams to meet department objectives. Responsibilities of this role include:
Supervise 10-12 Direct Reports which include UM Telephonic Nurses and UM Administration Coordinators (in a virtual setting).
Support and collaborate with the Retail Medical Directors, Value Based/Innovative Home Care Director, Strategy Advancement Advisor, Resolution team, UM team, and internal/external partners.
Research operational issues as reported by the Resolution Team, Medical Director team, and UM team.
Identify opportunities to improve operational processes and develop new processes for expansion markets.
Outcome Analysis: Research to seek answers to relevant clinical, operational, & financial questions, and identify areas for improvement.
Monitor performance and address areas of concern.
Analyze data and support strategy development based on findings.
Success in this role requires:
Ability to lead teams, communicate and provide feedback in a way that maintains associate empowerment and engagement.
Strong critical thinking, problem solving skills; detailed and well-organized.
Ability to break down complex problems into actionable steps.
Demonstrated accuracy and thoroughness, with ability to identify process improvements.
Relationship management skills
Ability to work independently under general instructions and within a team.
Required Qualifications
Bachelor's Degree or BSN
Licensed Registered Nurse (RN) with no disciplinary action.
Compact State License or the ability to obtain a compact license.
Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
5 or more years of clinical experience
UM workflow and process experience.
CGX experience
Strong written and verbal communication skills (ability to interact effectively with people at all levels within a team or internal division)
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, PowerPoint and Teams.
Work-At-Home Requirements
Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.
Must provide 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 25mbs download x 10mbs upload is recommended.
Preferred Qualifications
2 or more years of management experience
Home health and/or UM experience
Health Plan experience
Prior Medicare experience
Additional Information
As part of our hiring process for this opportunity, we will be using an exciting new technology called Modern Hire SMS Text Messaging to enhance our hiring and decision-making ability. Modern Hire Text Messaging allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Alert:
Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.
Scheduled Weekly Hours
40
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
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