Utilization Management Nurse 2

Employment Type: Full-time

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. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

• 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 in Humana’s Florida LTSS program.
• 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

• Active Licensed Practical Nurse (LPN) or Licensed Registered Nurse (RN) in the state of Florida with no disciplinary action.
• Minimum of one (1) year of LTSS (Long Term Supports and Services) experience.
• Previous experience in utilization management.
• Comprehensive knowledge of Microsoft Word, Outlook, and Excel.

Preferred Qualifications

• Bachelor's degree.
• Previous Medicare/Medicaid experience.
• Previous case management experience.
• Previous CGX experience.
• MCG certification.

Workstyle & Location

• Workstyle: Home (Remote, with occasional office space use for collaboration).
• Work Location: Must reside in Florida.
• Travel: No more than 5% based on business needs.
• Typical Work Days/Hours: Monday – Friday, 8:30 am – 5:00 pm EST.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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.
• Employees who live and work from Home in the states 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 employees 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.

Application Instructions

• HireVue: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
• Social Security: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time, and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance