Utilization Management Nurse

2 weeks ago


Louisville, Kentucky, United States Humana Full time
Job Summary

We are seeking a skilled 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
  • Coordinate and communicate with healthcare providers and members to facilitate optimal care and treatment.
  • Utilize clinical knowledge and critical thinking skills to interpret medical criteria, policies, and procedures.
  • Make decisions regarding own work methods and require minimal direction.
  • Follow established guidelines and procedures.
Work Environment

This role requires a combination of remote work and onsite visits to our facilities in Louisville and Lexington, Kentucky. You must reside within 30 miles of either location.

Requirements
  • Licensed Registered Nurse (RN) in the state of Kentucky with no disciplinary action.
  • Minimum 1 year in-hospital Utilization Management experience.
  • Minimum 2 years Progressive clinical experience in an acute hospital setting, skilled nursing or rehabilitation clinical setting.
  • Strong proficiency with MS Office Suite.
Preferred Qualifications
  • Bachelor's Degree.
  • MCG experience.
  • 1+ year Care Management experience in an acute care, skilled or Rehabilitation clinical setting.
  • Certified Case Manager, CCM.
  • Health Plan experience.
  • Medicaid experience.
Benefits

Humana offers a competitive benefits package, including health benefits, paid time off, holidays, volunteer time, and jury duty pay. We also offer recognition pay, 401(k) retirement savings plan, tuition assistance, scholarships for eligible dependents, parental and caregiver leave, employee charity matching program, and career development opportunities.



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