Utilization Management Registered Nurse

Job Description:

Utilization Management Registered Nurse

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.

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.

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

Required Qualifications

• Minimum three (3) years of Medical Surgery, Heart, Lung, maternity/obstetrics, or Critical Care Nursing experience required

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

• Intermediate to advanced knowledge of Microsoft Word, Outlook and Excel, systems and platforms

• Ability to work independently under general instructions and with a team

Preferred Qualifications

• Bachelor's degree

• Previous experience in utilization management

• Health Plan experience

• Previous Medicare/Medicaid Experience a plus

• Bilingual is a plus

Workstyle: Remote work at home

Location: US

Schedule: Monday through Friday 8:00 AM to 5:00 PM Eastern, with ability to work over-time, weekends as needed to support business needs.

Travel: Less than 5%

Scheduled Weekly Hours:

40

Pay Range:

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits:

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us:

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.

Equal Opportunity Employer:

Humana does not discriminate against any employee or applicant for employment because of protected status.