Utilization Management Nurse

Humana • Louisiana, MO

1d • 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. This role 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. You will report to the Manager Care Management and support the Medicaid CM Team. In this role you will: 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. Use your skills to make an impact

Requirements

• Licensed Registered Nurse (RN) in the state of Louisiana with no disciplinary action with the ability to be licensed in multiple states
• 3+ years of varied RN nursing experience (Strong med surg, ICU, ER, acute experience)
• Experience in Utilization Management Review and/or Prior Authorization
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Ability to work independently under general instructions and with a team
• Location: Must reside and conduct work in the state of Louisiana
• Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM Central Time, over-time and a weekend rotation may be requested to meet business needs

Nice To Haves

• Education: BSN or Bachelor's degree in a related field
• Health Plan experience
• Previous Medicare/Medicaid Experience a plus
• Bilingual Creole OR Spanish is a plus
• Experience with MCG guidelines
• Compact Nursing License

Responsibilities

• Utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.
• Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
• 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.

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