Utiliizaiton Management Nurse

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 state of Florida with no disciplinary action.

3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience

Previous experience working in-hospital or Insurance utilization management

Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting

Comprehensive knowledge of Microsoft Word, Outlook and Excel

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

Work Style: Remote Work at Home

Location: Must reside witihn 60 miles of Orlando or Tampa Florida

Hours: Must beable to work an 8 hour shift between the hours of 8:00-5:00 PM Eastern Time Monday through Friday

Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work

Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)

Preferred Qualifications

Bachelor's degree

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/Medicaid Experience a plus

Call center or triage experience

Bilingual Language in both English and Spanish - Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages.

Additional Information

Scheduled Weekly Hours

40

Company info

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