Remote Manager, Utilization Management, Registered Nurse, RN

The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The Manager, Utilization Management Nursing 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.
• Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
• Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
• Manager will travel twice a year to South Florida to attend meetings (See Additional Information below)

Required Qualifications

• Unrestricted Registered Nurse (RN) License in the state of Florida without disciplinary action
• Minimum 1 year experience with any of the following Team Leadership, Project Leadership, or Subject Matter Expert, SME
• Minimum 1-year progressive clinical experience preferably in an acute care clinical setting
• Minimum 1 year Utilization Management Experience
• Intermediate to advanced computer skills and experience with Microsoft Suite, Word, Excel, Outlook.
• Exceptional communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.

Workstyle: Remote Work at Home

Location: Florida

Schedule:

• Typically, Monday-Friday 8:00 AM – 5:00 PM EST
• Rotating on-call coverage and oversight during weekends and holidays.

Travel: Minimum twice a year to attend meetings in Florida

Work at Home Guidance To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Prior supervisory experience hiring, training, coaching and up to termination
• Health Plan experience
• Prior Medicaid experience
• Triage experience
• Bilingual proficiency

Additional Information

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Modern Hire Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first-round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Modern Hire Voice interview. In this interview, you will listen to a set of interview questions over your phone, and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

#L1-Remote

Scheduled Weekly Hours

40