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RN Telephonic Utilization Management Nurse 2 - Metairie LA or Baton Rouge LA Office Based
Company name
Humana Inc.
Location
Baton Rouge, LA, United States
Employment Type
Full-Time
Industry
Healthcare, Nursing
Posted on
Sep 22, 2021
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
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. 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.
Required Qualifications
Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action.
3-5 years of acute and critical care clinical experience
Comprehensive knowledge of Microsoft Word, Outlook and Excel with the ability to type and enter data accurately
Ability to work independently under general instructions and with a team
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
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
Preferred Qualifications
Education: BSN or Bachelor's degree in a related field
Previous experience in utilization management
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Bilingual is a plus
Additional Information
Hours for this role are: Monday-Friday, 8am-5pm CST
This is an office based role in Metairie or Baton Rouge, LA. (Currently this role is full time work at home due to COVID-19 and will remain so until it is considered safe for associates to return to normal business operations)
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com
Location : Baton Rouge, LA
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Employer job 
90 Day Old Job 
