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Utilization Management RN Specialist
2 months ago
The Utilization Management Registered Nurse 2 employs clinical nursing expertise to facilitate the coordination, documentation, and communication of medical services and benefit administration decisions. The responsibilities of the Utilization Management Nurse 2 are diverse and often necessitate interpretation and independent judgment regarding the appropriate courses of action.
The Utilization Management Registered Nurse 2 applies clinical knowledge, communication abilities, and independent critical thinking to interpret criteria, policies, and procedures, ensuring the delivery of optimal treatment, care, or services for members. This role involves coordinating and communicating with providers, members, and other stakeholders to promote effective care and treatment. A comprehensive understanding of departmental, segment, and organizational strategies and objectives, along with their interconnections to related areas, is essential. The nurse makes decisions about their work methods, occasionally in ambiguous situations, requiring minimal direction while seeking guidance when necessary. Adherence to established guidelines and procedures is expected.
Utilize your expertise to create a positive impact
Required Qualifications
- Active Registered Nurse (RN) license in the appropriate state without any disciplinary actions.
3+ years of experience in Skilled Nursing Facilities
Prior experience in Utilization Management is essential
Clinical experience in an acute care, skilled, or rehabilitation setting is preferred.
Proficient knowledge of Microsoft Word, Outlook, and Excel is required.
Ability to work independently under general instructions and collaboratively within a team.
A high-speed DSL or cable modem is necessary for a home office (Satellite and Wireless Internet service is not permitted for this role). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) is required for optimal performance.
A passion for contributing to an organization dedicated to enhancing consumer experiences is essential.
Preferred Qualifications
Education: BSN or a Bachelor's degree in a related field.
Experience in a Health Plan setting.
Previous Medicare/Medicaid experience is advantageous.
Experience in call centers or triage is beneficial.
Bilingual candidates are encouraged to apply.
Additional Information
Scheduled Weekly Hours
40
Compensation Range
The compensation range provided reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The pay range may vary based on geographic location and individual pay will differ based on demonstrated job-related skills, knowledge, experience, education, certifications, etc. $69,800 - $96,200 per year. This position is eligible for a bonus incentive plan based on company and/or individual performance.
Benefits Overview
Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support holistic well-being. Associate benefits are designed to promote personal wellness and informed healthcare decisions for you and your family, recognizing that life extends beyond work. Among our benefits, Humana provides medical, dental, and vision coverage, a 401(k) retirement savings plan, paid time off (including personal holidays, volunteer time off, and paid parental leave), short-term and long-term disability, life insurance, and various other opportunities.
About Us
Humana Inc. is dedicated to prioritizing health for our teammates, customers, and the organization. Through our insurance services and healthcare offerings, we strive to facilitate better health outcomes for the millions we serve, ensuring they receive the care and services they need when necessary. Our initiatives contribute to an improved quality of life for individuals across various demographics.
Equal Opportunity Employer
Humana is committed to creating a diverse environment and is proud to be an equal opportunity employer. We do not discriminate against any employee or applicant based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. Our policy includes taking affirmative action to employ and advance in employment all persons, regardless of their background, and to base all employment decisions solely on valid job requirements.
