Remote Utilization Management Nurse, Home Solutions, KY

Humana

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Location: Louisville, KY
Location Type: Louisville – Remote
Schedule: Full_time
Req: R-314240

Description

 

Full-Time, Remote Telephonic opportunity

As a Utilization Management RN working on the Home Solutions team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal at home. In this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.

Shift is Monday – Friday 8:00am – 5:00pm Eastern Standard Time
Rotational Evening, Weekends and Holiday coverage required (between 8 AM to 8 PM EST)

 

Responsibilities

 

— A secure home-office space, full-time uninterrupted work hours and hard-wired, high-speed internet service is required for this position —

 

The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Success in this role requires the following:

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
  • Excellent organizational and time management skills
  • Solid analytical skills to understand and interpret data to make recommendations to improve patient care.
  • Technical savvy and ability to navigate multiple systems and screens while working cases.
  • Collaboration skills to effectively interact with multiple parties both internal and external.
  • An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
  • Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed.
  • Ability to follow established guidelines/procedures.
#LI-Remote

               

Required Qualifications

  • Minimum of associate degree in nursing
  • Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
  • Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
  • Three (3) or more years of progressive clinical experience
  • Effective telephonic and virtual communication skills
  • Comprehensive knowledge of Microsoft Word, Outlook and Excel
  • Ability to work independently under general instructions and within a team.

Work-At-Home Requirements

  • Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
  • A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.
  • Check your internet speed at www.speedtest.net
  • A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.

Preferred Qualifications

  • BSN
  • 2 to 3 years of home health experience and/or utilization management experience
  • Experience in a managed care setting
  • Health Plan experience
  • CGX experience
  • Bilingual in English/Spanish

Additional Information

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire SMS Text Messaging to enhance our hiring and decision-making ability. Modern Hire Text Messaging 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.

 

ALERT: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website. #LI-Remote

 

Scheduled Weekly Hours

 

40