Utilization Management Nurse

Humana

70d • $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

• Active licensed Registered Nurse (RN) in the state of Virginia or obtain a multi-state license in a state that participates in the enhanced licensure (eNLC) with no disciplinary action.
• At least 2 years prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
• Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint.
• Ability to navigate multiple systems and troubleshoot basic technical difficulties.
• Strong oral, written, and interpersonal communication skills.
• Problem-solving and facilitation skills.

Nice To Haves

• BSN or Bachelor's degree in a related field.
• Previous experience in utilization management.
• Health Plan experience, Medicare/Medicaid experience.

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
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees