Post-Acute Utilization Management Nurse Specialist

4 weeks ago


Jefferson City, Missouri, United States Humana Full time
Job Summary

We are seeking a skilled Post-Acute Utilization Management Nurse to join our team at Humana. As a key member of our healthcare team, you will play a critical role in ensuring that our members receive the best possible care and services.

Key Responsibilities
  • Utilize clinical knowledge and critical thinking skills to review cases and make informed decisions about medical services and benefit administration determinations.
  • Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment.
  • Develop and implement effective care plans that meet the unique needs of our members.
  • Collaborate with other healthcare professionals to ensure seamless care transitions and optimal outcomes.
Requirements
  • Licensed Registered Nurse (RN) in Illinois, Minnesota, or Compact license required, with no disciplinary action.
  • 2+ years of Post-Acute clinical experience in a SNF, LTACH, or Rehab setting.
  • Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
  • Ability to work independently under general instructions and as part of a team.
Preferred Qualifications
  • Bachelor's degree in nursing (BSN).
  • Previous experience in Discharge Planning or Utilization Management.
  • Experience working with Milliman MCG or CMS guidelines.
  • Health Plan experience.
  • Previous Medicare/Medicaid experience a plus.
Work Environment

This is a remote position, and you will be working from a dedicated space with a reliable internet connection. You will be required to work independently and make decisions with minimal supervision.

Benefits

As a Humana employee, you will be eligible for a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and more.


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