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Utilization Management Registered Nurse 2
2 months ago
Overview:
Become an integral part of our compassionate community and prioritize health.
Role Summary:
The Utilization Management Registered Nurse 2 employs clinical nursing expertise to enhance the coordination, documentation, and communication of medical services and benefit administration decisions.
This position involves diverse responsibilities that often necessitate interpretation and independent judgment regarding the most suitable courses of action.
Key Responsibilities:
The Utilization Management Registered Nurse 2 applies clinical knowledge, effective communication, and critical thinking skills to interpret guidelines, policies, and procedures, ensuring optimal treatment and care for members. Responsibilities include:
- Facilitating communication with providers, members, and other stakeholders to ensure the best possible care and treatment.
- Understanding departmental, segment, and organizational strategies and objectives, including their connections to related areas.
- Making informed decisions regarding work methods, even in ambiguous situations, with minimal supervision while seeking guidance when necessary.
- Adhering to established protocols and procedures.
Qualifications:
Required:
- Active Registered Nurse (RN) license in the appropriate state with no disciplinary actions.
- Compact License is mandatory.
- Minimum of 3 years of experience in a Skilled Nursing Facility.
- Prior experience in utilization management is essential.
- Clinical experience in acute care, skilled, or rehabilitation settings is preferred.
- Proficient in Microsoft Word, Outlook, and Excel.
- Ability to work independently under general guidance and collaboratively within a team.
Technical Requirements:
Must provide a high-speed DSL or cable modem for home office use (Satellite and Wireless Internet services are not permitted). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) is required.
Preferred Qualifications:
- Bachelor of Science in Nursing (BSN) or a related field.
- Experience in a Health Plan environment.
- Previous Medicare/Medicaid experience is advantageous.
- Call center or triage experience is a plus.
- Bilingual candidates are encouraged to apply.
Additional Information:
Scheduled Weekly Hours: 40
Compensation:
The salary range reflects a good faith estimate of starting base pay for full-time employment. Individual pay may vary based on geographic location, skills, knowledge, experience, education, and certifications. The range is $69,800 - $96,200 per year, with eligibility for a bonus incentive plan based on performance.
Benefits:
Humana, Inc. and its subsidiaries offer competitive benefits that promote overall well-being. Our benefits are designed to support personal wellness and informed healthcare decisions for you and your family, recognizing that life extends beyond work. Benefits include:
- Medical, dental, and vision coverage.
- 401(k) retirement savings plan.
- Paid time off, including personal holidays and volunteer time.
- Short-term and long-term disability coverage.
- Life insurance and various other opportunities.
About Humana:
Humana Inc. (NYSE: HUM) is dedicated to prioritizing health for our teammates, customers, and the organization. Through our insurance and healthcare services, we strive to simplify the journey to optimal health for millions, ensuring they receive the necessary care and support.
Equal Opportunity Employer:
Humana is committed to a policy of non-discrimination in employment practices. We take affirmative action to employ and advance in employment all qualified individuals, ensuring that all employment decisions are based solely on valid job requirements.
