SNF Utilization Management RN - Compact Rqd

Humana • London, ND

107d • $71,100 - $97,800

About The Position

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.

Requirements

• Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action.
• Must have Compact License.
• Greater than one year of clinical experience in an RN role in an acute care setting.
• Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
• Ability to work independently under general instructions and with a team.
• Passionate about contributing to an organization focused on improving consumer experiences.

Nice To Haves

• BSN or Bachelor's degree in a related field.
• Three or more years of clinical experience in an acute care setting.
• Experience as an MDS Coordinator or discharge planner in an acute care setting.
• Previous experience in utilization management/utilization review for a health plan or acute care setting.
• Compact license PLUS a single state RN Licensure in non-compact states like California, Hawaii, Nevada, Oregon.
• Health Plan experience.
• Previous Medicare/Medicaid Experience.
• Call center or triage experience.
• Bilingual.

Responsibilities

• Utilize clinical nursing skills to support coordination and documentation of medical services.
• Interpret criteria, policies, and procedures to provide appropriate treatment and care.
• Coordinate and communicate with providers and members to facilitate optimal care.
• Make independent decisions regarding work methods in ambiguous situations.
• Follow established guidelines and procedures.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, volunteer time off.
• Paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.

What This Job Offers

• Job Type: Full-time
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees