Location Type: Remote
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 Post-Acute Utilization Management Nurse 2:
- Review cases using 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.
- Provider calls
- Licensed Registered Nurse (RN) in Texas, Arkansas, Oklahoma or Compact license required, with no disciplinary action
- 2+ years of Post-Acute clinical experience in a SNF, LTACH or Rehab setting
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- Ability to work independently under general instructions and with a team
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Bachelor’s degree in nursing (BSN)
- Previous experience in Discharge Planning or Utilization Management
- Experience working with Milliman MCG or CMS guidelines
- Health Plan experience
- Previous Medicare/Medicaid Experience a plus
- Bilingual is a plus
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
- Work Hours are: Monday-Friday 8am-5pm CST, weekend and overtime hours are based on business needs (Candidates hired will be required to work in the CST zone)
- This is a remote position
Scheduled Weekly Hours
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$69,800 – $96,200 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.
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