Clinical Utilization Management Specialist

2 days ago


Salem, Oregon, United States Humana Full time
Job Description

As a Utilization Management Nurse 2 at Humana, you will utilize your clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.

The successful candidate will have the ability to review cases using clinical knowledge, communication skills, and independent critical thinking skills to interpret criteria, policies, and procedures.

The Post-Acute Utilization Management Nurse 2 will:

  1. Review cases using clinical knowledge and independent critical thinking skills to interpret criteria, policies, and procedures.
  2. Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
  3. Provide clinical decision support to ensure the best and most appropriate treatment, care, or services for members.

The ideal candidate will have 2+ years of Post-Acute clinical experience in a Skilled Nursing Facility, Inpatient Rehabilitation Facility, or Long-Term Acute Care facility.

A comprehensive knowledge of Microsoft Word, Outlook, and Excel is required, as well as the ability to work independently under general instructions and as part of a team.

Humana offers a competitive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and more.



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