Utilization Review Nurse
Sidecar HealthFull Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
Candidates must possess a valid RN license with no disciplinary actions and a Compact License. A minimum of 3 years of experience in a Skilled Nursing Facility or previous utilization management experience is required, along with prior clinical experience, preferably in an acute care, skilled, or rehabilitation setting. Comprehensive knowledge of Microsoft Word, Outlook, and Excel is necessary, as is the ability to work independently and as part of a team. Candidates must also have a high-speed DSL or cable modem (25mbs download/10mbs upload) and a dedicated, interruption-free home office space. Occasional travel may be required.
The Utilization Management Registered Nurse will utilize clinical nursing skills to coordinate, document, and communicate medical services and benefit administration determinations. This role involves interpreting criteria, policies, and procedures to ensure members receive the most appropriate treatment and care. Responsibilities include coordinating and communicating with providers, members, and other parties to facilitate optimal care, making independent decisions regarding work methods, and following established guidelines.
Health insurance provider for seniors and military
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.