Utilization Management Nurse - Home Solutions - Compact RN Required

Humana • NE

114d • $71,100 - $97,800

About The Position

Become a part of our caring community and help us put health first. This is a Full-Time, Remote Telephonic opportunity. 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. As a Utilization Management RN working on the OneHome/Home Solutions UM Team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal at home. In this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment. The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Success in this role requires the following: Must be passionate about contributing to an organization focused on continuously improving consumer experiences. Excellent organizational and time management skills. Solid analytical skills to understand and interpret clinical information to make recommendations to improve patient outcomes. Technical savvy and ability to navigate multiple systems and screens while working cases. Collaboration skills to effectively interact with multiple parties both internal and external. An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed. Ability to follow established guidelines, processes, and procedures. Use your skills to make an impact.

Requirements

• Minimum of Associate Degree in nursing.
• Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
• Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
• Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population.
• Effective telephonic and virtual communication skills.
• Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
• Ability to work independently under general instructions and within a team.

Nice To Haves

• Bachelor’s degree.
• Two (2) or more years of home health experience and/or utilization management experience.
• Experience in a managed care setting.
• Health Plan experience.
• CGX experience.

Responsibilities

• Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services.
• Interpret and determine appropriate courses of action for varied work assignments.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal member care.
• Ensure fully coordinated care at home for members.
• Make recommendations to improve patient outcomes based on clinical information.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including 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
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees