Clinical Utilization Nurse

3 weeks ago

Marquand, Missouri, United States Humana Full time

Join a dedicated team focused on health and wellness

Humana Healthy Horizons in Indiana is looking for skilled Utilization Management (UM) Nurses who apply their clinical expertise to enhance the coordination, documentation, and communication of long-term support services and benefit administration decisions. The role of the Utilization Management Nurse involves diverse tasks that often require independent judgment and interpretation of the best course of action.

Key Responsibilities:

  • Leverage clinical expertise, effective communication, and critical thinking to interpret guidelines, policies, and procedures, ensuring optimal treatment and care for members.
  • Facilitate communication and coordination with healthcare providers, members, and other stakeholders to ensure effective care delivery.
  • Understand and align with departmental and organizational strategies and objectives, recognizing their interconnections with related functions.
  • Make informed decisions regarding work methods, often in uncertain situations, while requiring minimal supervision and guidance when necessary.
  • Adhere to established protocols and procedures.

Utilize your expertise to make a difference

Required Qualifications:

  • Active Licensed Practical Nurse (LPN) certification in Indiana without any disciplinary actions.
  • Prior experience in utilization management is essential.
  • A minimum of 2 years of clinical experience, ideally in acute care, skilled nursing, or rehabilitation settings.
  • Familiarity with Medicare and Medicaid processes.
  • Proficient in Microsoft Word, Outlook, and Excel.
  • Capability to work autonomously under general guidance and collaboratively within a team.

Remote Work Requirements:

  • A minimum internet download speed of 25 Mbps and upload speed of 10 Mbps is recommended; a wired cable or DSL connection is preferred.
  • Satellite, cellular, and microwave connections may only be used with prior approval from management.
  • Humana will provide necessary telephone equipment for remote associates to meet business needs.
  • Work from a designated area free from interruptions to maintain confidentiality of member information.

Preferred Qualifications:

  • Ideally residing in Indiana.
  • Bachelor of Science in Nursing (BSN), Registered Nurse (RN) license, or a degree in a related field.
  • At least 1 year of experience working with vulnerable populations and assessing long-term support services.

Additional Information:

  • Work Environment: Primarily remote, with occasional onsite responsibilities at Humana Healthy Horizons offices.
  • Travel Requirements: Up to 10% travel within Indiana to Humana locations.
  • Core Work Schedule: Monday to Friday; 8:00 AM to 5:00 PM Eastern Standard Time (EST).
  • Benefits: Comprehensive benefits package effective from day one, including competitive pay, 401k, medical, dental, vision coverage, tuition assistance, and more.

Interview Process:

Our hiring process incorporates innovative interviewing technology provided by Hire Vue, enhancing our recruitment efforts. If selected, candidates will receive an invitation to participate in a pre-recorded voice interview or an SMS text messaging interview. The pre-recorded interview will involve responding to a series of questions via phone, expected to take approximately 10-15 minutes. The SMS text interview will consist of a series of questions answered through a cell phone or computer, lasting about 5-10 minutes. All recorded interviews will be reviewed to determine the next steps in the hiring process.

Scheduled Weekly Hours: 40

Compensation Range: The estimated starting salary for this full-time position ranges from $57,700 to $79,500 annually, subject to variation based on geographic location and individual qualifications.

Benefits Overview:

Humana, Inc. and its subsidiaries offer a competitive benefits package that promotes overall well-being. Our benefits are designed to support personal health and informed healthcare choices for employees and their families.

About Humana:

Humana Inc. is dedicated to prioritizing health for our employees, customers, and communities. Through our insurance and healthcare services, we strive to facilitate access to essential care, improving the quality of life for individuals across various demographics.

Equal Opportunity Employment:

Humana is committed to providing equal employment opportunities to all individuals, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We actively promote diversity and inclusion in our workforce.

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