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Utilization Management Nurse 2 ID-21257

Company:

Humana Inc. is a health insurance service provider focused on improving health and wellness for diverse populations.

Summary:

The Utilization Management Nurse 2 utilizes clinical nursing skills to support medical services coordination and documentation, making independent determinations on care actions. Applicants need an RN license and experience in utilization management, along with prior clinical experience and proficiency in Microsoft Office applications.

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Requirements:

Hard Skills: Comprehensive knowledge of Microsoft Word, Excel, Outlook

Credentials: Rn Licensure

Experience: Previous experience in utilization management required, Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting

Job Description:

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

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.

 

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.

Use your skills to make an impact

Required Qualifications

  • Rn Licensure
  • Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action.
  • Previous experience in utilization management required
  • Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
  • 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/Medicaid Experience a plus
  • Call center or triage experience
  • Bilingual is a plus
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