Utilization Management Nurse

Humana • Indianapolis, SC

1d • $71,100 - $97,800 • Remote

About The Position

The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 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

• Licensed Registered Nurse (RN) (Compaq License) with no disciplinary action.
• Bachelor's degree
• 3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
• Prior clinical experience preferably in an 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

Nice To Haves

• MCG/InterQual experience
• Previous experience in utilization management
• Health Plan experience
• Previous Medicare/Medicaid experience
• Call center or triage experience

Responsibilities

• Utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
• Interprets 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.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, 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