Utilization Management Registered Nurse - Home Health
About The Position
The Utilization Management Nurse 2 uses clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. Assignments are varied and often require interpretation and independent decisions about appropriate courses of action. The nurse helps ensure fully coordinated care at home for members. This is a remote, home-based position with a Monday–Friday schedule from 8:00 a.m. to 5:00 p.m. Eastern Standard Time and 40 scheduled hours per week. Occasional travel to Humana offices for training or meetings may be required. Employees must have qualifying high-speed internet and a dedicated work area without ongoing interruptions to support productivity and protect member PHI/HIPAA information. Florida-based applicants are subject to Florida Level 2 background screening.
Requirements
- Associate degree in nursing or higher.
- Active Registered Nurse (RN) license in a compact state with no disciplinary action; must have a valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
- At least three years of progressive and varied clinical experience, including direct patient care for the geriatric population.
- Effective telephonic and virtual communication skills.
- Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
- Ability to work independently under general instructions and as part of a team.
- Strong organizational and time management skills.
- Solid analytical skills to interpret clinical information and make recommendations to improve patient outcomes.
- Technical savvy and ability to navigate multiple systems and screens while working cases.
- Ability to make decisions about one's own work methods, including in occasionally ambiguous situations, with minimal direction and guidance where needed.
- Passion for contributing to an organization focused on continuously improving consumer experiences.
- For home work: high-speed DSL or cable modem service; satellite and wireless internet service are not allowed. Minimum internet speeds are 25 Mbps download and 10 Mbps upload.
- For home work: a dedicated office space without ongoing interruptions to meet productivity requirements and protect member PHI/HIPAA information.
Nice To Haves
- Bachelor’s degree.
- At least two years of home health experience and/or utilization management experience.
- Experience in a managed care setting.
- Health Plan experience.
- CGX experience.
Responsibilities
- Support the coordination, documentation, and communication of medical services and benefit administration determinations.
- Interpret clinical information and independently determine appropriate courses of action.
- Help ensure fully coordinated care at home for members.
- Follow established guidelines, processes, and procedures.
- Collaborate and communicate with internal and external parties.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Bonus incentive plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
