RN Utilization Review Nurse- Weekend Friday-Monday 7:30am-5:30pm

Profile

Description

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Creating Healthy Communities is good for the Soul. Join Us! The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.

Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment

Coordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning including to assist with social determinants and closing gaps

Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas

Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed

Follows established guidelines/procedures

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications

Licensed Registered Nurse (RN) in the state of Florida or compact license with no disciplinary action.

3 - 5 years of clinical experience in acute care setting required

Previous experience in utilization management required

Comprehensive knowledge of Microsoft Word, Outlook and Excel

Ability to work independently under general instructions and with a team

Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

3 or more years experience in a high volume community or mail order pharmacy practice environment

Education: BSN or Bachelor's degree in a related field

Health Plan experience

Previous Medicare Experience a plus

Call center or triage experience

Bilingual is a plus

Additional Information

Work Schedule: 10 hours shift 7am - 5:30pm on Friday to Monday

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com