Clinical UM Registered Nurse

CenterWell

2d • Remote

About The Position

Become a part of our caring community As a Utilization Management Nurse 2, you will use 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. You will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Use your skills to make an impact

Requirements

• Active Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non compact licensure
• 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
• Prior clinical experience in acute care, skilled or rehabilitation clinical settings
• Comprehensive knowledge of Microsoft Word, Outlook and Excel)
• 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+ years of experience working in a high-volume and fast paced environment
• Previous experience in utilization management
• BSN or bachelor's degree in a related field
• Health Plan experience
• Previous Medicare/Medicaid Experience
• Call center or triage experience
• Bilingual English and Spanish (read/write/speak)

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