Clinical Utilization Management Nurse
4 weeks ago
We are seeking a skilled Utilization Management Nurse to join our team at Humana. As a Utilization Management Nurse, you will play a critical role in supporting the coordination, documentation, and communication of medical services and/or benefit administration determinations.
Key Responsibilities- Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
- Interpret and apply clinical knowledge, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.
- Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
- Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
- Licensed Registered Nurse (RN) with a compact license and no disciplinary action.
- At least 3 years of varied clinical nursing experience, preferably in an acute care, hospital, skilled, or rehabilitation clinical setting.
- Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
- Ability to work independently under general instructions and with a team.
- Bachelor's degree in nursing (BSN).
- Utilization management experience, including following MCG/Milliman or Interqual guidelines.
- CCM Certification.
- Health Plan experience.
- Previous Medicare/Medicaid experience.
- Call center or triage experience.
This is a remote position with a dedicated workspace, and you will be required to work from a location with a reliable internet connection.
BenefitsHumana offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and short-term and long-term disability insurance.
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Utilization Management Nurse
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