Clinical UM Nurse

CenterWell Home Health • Louisville, KY

3d • Remote

About The Position

Become a part of our caring community and help us put health first 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. Use your skills to make an impact

Requirements

• Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non compact licensure
• No less than 3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience required
• 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 within 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
• Must be willing to be in weekend rotation and possible holiday coverage.

Nice To Haves

• 3 or more years' experience in a high volume and fast paced environment
• Previous experience in utilization management
• 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 is a plus

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees