Job Description: Utilization Management Nurse 2

Position Overview

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. This role's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

This position is considered remote/work at home and may require 5% travel to market offices to support business needs. Work hours are Monday-Friday, 8 am - 5 pm EST.

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.

This position will support CarePlus and will entail aspects of case management for discharge planning Medicare members from SNF/rehab facilities. It will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.

Additional responsibilities include understanding department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Make 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.

Requirements

• Active Registered Nurse (RN) license in, or including, the state of Florida with no disciplinary action.
• Must reside in Florida.
• Minimum of 2 years clinical experience in hospital acute care experience with a broad background to include ICU, CCU, ER, and Med Surg and/or a combination of skilled, rehabilitation, or long-term care.
• Excellent computer skills and ability to navigate easily using multiple applications.
• Proficiency in Microsoft Word, Excel, Outlook, and One Note.
• Ability to travel 5% to market offices for business needs.

Preferred Qualifications

• Utilization management and/or Case Management experience.
• Health Plan experience.
• Previous experience with Medicare/Medicaid criteria.
• Experience with CMS guidelines.

Remote Work at Home Requirements

• Must have the ability to provide a high-speed DSL or cable modem for a home office.
• Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mbps download x 10mbps upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Screening

• Associates working in the State of Florida will need Completion of a Level II; AHCA background clearance and Fingerprinting.

Additional Information

• As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
• If participating in a SMS Text Screening, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. The duration is 5-10 minutes. Your responses will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Employment Type

Full time

Scheduled Weekly Hours

40

Pay Range

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 will vary based on demonstrated job-related skills, knowledge, experience, and education.