Remote Utilization Management Nurse, Metairie, LA

Location: Metairie, LA
Location Type: Metairie – Remote
Schedule: Full_time
Req: R-318154

Description

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.

Responsibilities

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.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Required Qualifications

• Licensed Registered Nurse (RN) in the state of Louisiana with no disciplinary action with the ability to be licensed in multiple states
• 3+ years of varied RN nursing experience (Strong med surg, ICU, ER, acute experience)
• Previous experience in Utilization Management Review and/or Prior Authorization
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Ability to work independently under general instructions and with a team
• Location: Must reside in the state of Louisiana
• Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM  Central Time, over-time and a weekend rotation may be requested to meet business needs
• Training: November 6th, 2023

Preferred Qualifications

• Education: BSN or Bachelor’s degree in a related field
• Health Plan experience
• Previous Medicare/Medicaid Experience a plus
• Bilingual Creole OR Spanish is a plus
• Experience with MCG or Interqual guidelines

Work-At-Home Requirements

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

Additional Information

Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

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Scheduled Weekly Hours

40