Utilization Management Nurse - Onsite

Humana

6d • Hybrid

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, discharges 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 at an on-site facility. This position will have a limited hybrid with some hours working at home at leader discretion. Candidate must be local, within about a 30-minute driving distance to HCA St. Lucie Medical Center, in Palm Beach County, from home base. The Utilization Management Nurse 2 is an Onsite Nurse located at HCA St. Lucie Medical Center who 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 our Medicare members. Coordinate and communicate with providers, members, case managers PCP or other parties to facilitate appropriate discharge planning, assist with social determinants and closing gaps to facilitate optimal care and treatment. Identify barriers to discharge and avoidable readmissions Understands department, segment, and organizational strategy and operating objectives, including how they interrelate to each area Works independently, makes appropriate decisions, requires minimal direction and seeks guidance where needed Evaluate and refer to other programs available to Member Follows established guidelines/procedures This is an Onsite / Hybrid position at HCA St. Lucie Medical Center, located in St. Lucie, Florida. The ideal candidate must be located no more than a 30-minutes driving distance to the Onsite location from their home base. This position will work at an Onsite facility and as a Hybrid, will have limited working hours at home based on the leader’s discretion. Use your skills to make an impact

Requirements

• RN License without restrictions in the state of Florida
• Must be located no more than 30-minutes driving distance to HCA St. Lucie Medical Center from home base
• 2 or more years of clinical experience preferably in an adult/geriatric acute care, skilled or rehabilitation clinical setting
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Ability to work independently under general instructions and with a team.
• Independent critical thinking skills
• Strong written and verbal communication skills
• Valid Driver’s License and/or dependable transportation necessary
• Travel to Hospital/Provider for onsite reviews to assist Members
• This role is considered patient facing. If selected for this role, you will be required to meet criteria to be onsite with Providers/Hospitals/Health Care Facilities
• This hybrid position will have limited hours working at home at the leader’s discretion
• This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Nice To Haves

• Bachelor’s degree in nursing (BSN)
• Previous experience in discharge planning, utilization management or case management a plus
• Health Plan experience
• Previous Medicare/Geriatric Experience a plus
• Bilingual is a plus

Responsibilities

• Coordinate and communicate with providers, members, case managers PCP or other parties to facilitate appropriate discharge planning, assist with social determinants and closing gaps to facilitate optimal care and treatment.
• Identify barriers to discharge and avoidable readmissions
• Understands department, segment, and organizational strategy and operating objectives, including how they interrelate to each area
• Works independently, makes appropriate decisions, requires minimal direction and seeks guidance where needed
• Evaluate and refer to other programs available to Member
• Follows established guidelines/procedures

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
• Number of Employees: 5,001-10,000 employees