Remote Utilization Management Review Nurse, OH

Location:Cincinnati, OH
Location Type:Cincinnati – Remote
Additional Location: CT; DE; FL; GA; IN; KY; ME; MD; MI; NY; NC; PA; RI; SC; TN; VT; VA; WV;
Schedule: Full_time
Req: R-313889

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.

How we Value You
Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being

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

This is a remote position

#LI-Remote

#LI-MH1

Required Qualifications

• Licensed Registered Nurse (RN) with no disciplinary action
• 3 – 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience required
• Previous experience in utilization management required
• Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical 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
• This role is considered patient facing and is part of Humana/Senior Bridge’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB

Preferred Qualifications

• Bachelor’s degree
• Health Plan experience
• Previous Medicare/Medicaid Experience a plus
• Call center or triage experience
• Bilingual is a plus

Additional Information

About Humana

Your growth is what drives Humana forward.

• When you get here, the journey is just beginning.
• Our leaders are committed to understanding what you need to grow
• Because we don’t grow without you
• This is a place where our nurses influence the C-suite
• Where software engineers change lives
• Where every associate can build a professional path where they learn and thrive
• Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security
• Because finding new ways to put health first—for our members and patients and our associates alike—is what we do

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

Interview Format

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 or computer 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