Manager, Utilization Management Nursing

Humana

4d • $94,900 - $130,500 • Remote

About The Position

The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Manager, Utilization Management Nursing 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. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Requirements

• Active Licensed Registered Nurse (RN) in Virginia or enhanced compact license, (eNLC) with no disciplinary action
• Minimum 2 years of team lead and/or project lead experience
• Minimum 2 years progressive clinical experience preferably in an acute care, skilled or rehabilitation setting
• Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
• Ability to work independently under general instructions and with a team

Nice To Haves

• Bachelor's Degree
• Prior supervisory experience which may include interviewing, hiring, training, performance evaluation, coaching and up to termination.
• Utilization management
• Prior experience within discharge planning, case management
• Health Plan experience
• Prior Medicare / Medicaid experience
• Call center or triage experience
• Bilingual is a plus

Responsibilities

• Utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.
• Applies advanced technical knowledge to solve moderately complex problems.
• Receives assignments in the form of objectives and determines approach, resources, schedules and goals.
• 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.
• Conducts briefings and area meetings.
• Maintains frequent contact with other managers across the department.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree