Utilization Management RN- remote FL

Humana • Work at Home - Florida, FL

1d • $71,100 - $97,800 • Remote

About The Position

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. The Utilization Management Nurse 2 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. Follows established guidelines/procedures.

Requirements

• Bachelor's degree
• Licensed Registered Nurse (RN) in the Florida with no disciplinary action.
• 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
• 1+ year of clinical experience- preferably in an acute care, skilled or rehabilitation clinical setting
• Must physically reside in the state of Florida
• Download speed of 25 Mbps and an upload speed of 10 Mbps is required for internet service.
• Wireless, wired cable or DSL connection is suggested for internet service.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• BSN or Bachelor's degree in a related field
• Health Plan experience
• Experience in utilization management
• Medicare/Medicaid experience
• Case Management experience
• Bilingual English/Spanish

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.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Follows established guidelines/procedures.

Benefits

• 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
• bi-weekly payment for internet expense (for employees in California, Illinois, Montana, or South Dakota)
• telephone equipment appropriate to meet the business requirements for their position/job

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level