Remote Utilization Management Registered Nurse, RN

Humana

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Location: SC
Location Type: Remote
Schedule: Full_time
Req: R-327800

Become a part of our caring community and help us put health first

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.
  • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
  • Follows established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

  • Current Unrestricted Licensed Registered Nurse (RN) in the state of South Carolina with no active disciplinary action.
  • Live within the state of South Carolina
  • 2 years clinical acute care, skilled nursing, rehab or transitional care experience.
  • 1 year experience in utilization management
  • 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

Additional Information / Adherence

 

Workstyle: Remote Work at Home

Location: U.S

Required Location: South Carolina

Schedule

  • Work Schedule: Monday – Friday; 8am – 5pm

Travel: 5%

  • Occasional travel up to 1 time per quarter

Additional Requirements

  • Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work.
  • 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 of 25×10 (25mbs download x 10mbs upload) is required.

Preferred Qualifications

  • Bachelor’s degree
  • Health Plan experience
  • Behavioral Health experience

 

Additional Information

 

Interview Process

 

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

 

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

 

Scheduled Weekly Hours

 

40

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

 

Equal Opportunity Employer

 

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.