Utilization Management Nurse

Humana • Louisiana, MO

3d • Remote

About The Position

The Utilization Management Nurse 2 uses 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. This role reports to the Manager Care Management and supports the Medicaid CM Team.

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
• Must reside and conduct work in the state of Louisiana

Nice To Haves

• 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

Responsibilities

• Understand department, segment, and organizational strategy and operating goals, 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.

Benefits

• medical
• dental
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree