Responsibilities
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.
Required Qualifications
Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
3-5 years of Medical Surgical nursing experience
3-5 years of clinical experience preferably in an acute care clinical setting
Bedside nursing experience should be within the last 6 years
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to research and problem solve independently
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. If selected for this role, you will be required to be screened for TB
Preferred Qualifications
Bachelor’s Degree in Nursing
Previous experience in discharge planning, utilization management or case management a plus
Critical care nursing experience a plus
Health Plan experience
Previous Medicare a plus (Medicare/Geriatric experience)
Work-At-Home Requirements
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense
A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required
Satellite and Wireless Internet service is NOT allowed for this role
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Additional Information
Hours for this role are: Monday-Friday 8am-5pm EST
Work location: This role requires being onsite daily at Norton Audubon Hospital, Louisville, KY
Currently this role is full time work at home due to COVID-19. We will return to the facility location when Humana and the acute facility approves for associates to be onsite at healthcare facilities once again
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Scheduled Weekly Hours
40