Utilization Management Nurse 2

Humana • Indianapolis, MI

7d • Remote

About The Position

Become a part of our caring community and help us put health first 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 UM Nurse 2 will- Uses clinical knowledge, communication skills, and independent critical thinking skills towards:. Interpreting criteria, policies, and procedures related to Long Term Services and Support authorizations to provide the best and most appropriate treatment, care, or services for members. Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment. Understand department and organizational strategy and operating objectives, including their linkages to related areas. Follow established guidelines/procedures. Make decisions regarding own work methods, occasionally in ambiguous situations, requires minimal direction and receives guidance where needed. Use your skills to make an impact

Requirements

• Must reside in Michigan or within 40 miles of the border in Indiana or Ohio.
• Active Registered Nurse (RN) in the state of Michigan with no disciplinary action.
• 1-year previous experience in utilization management/LTSS service authorization.
• At least 2 years prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting, or Medicaid Managed Care Organization.
• Comprehensive knowledge of Microsoft Word, Outlook and Excel.
• Ability to work independently under general instructions and with 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.

Nice To Haves

• Bachelor’s or Associate’s Degree in Nursing or other related field.
• Previous Medicare/Medicaid experience.
• NCQA, CM experience.
• Previous experience in discharge planning and/or home health or rehabilitation.
• Bilingual preferred (Spanish, Arabic, Chaldean Neo-Aramaic or other).

Responsibilities

• Interpreting criteria, policies, and procedures related to Long Term Services and Support authorizations to provide the best and most appropriate treatment, care, or services for members.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
• Understand department and organizational strategy and operating objectives, including their linkages to related areas.
• Follow established guidelines/procedures.
• Make decisions regarding own work methods, occasionally in ambiguous situations, requires minimal direction and receives guidance where needed.

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
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees