Responsibilities

The Utilization Management Nurse 2 will coordinate and communicate with providers, members, case managers, and PCPs to facilitate appropriate discharge planning, assist with social determinants, and close gaps to ensure optimal care and treatment. They will identify barriers to discharge and avoidable readmissions, evaluate and refer to other programs available to members, and follow established guidelines and procedures. The nurse will use clinical knowledge and independent critical thinking skills to interpret criteria, policies, and procedures, providing the best and most appropriate treatment, care, or services for Medicare members. They will also work independently, make appropriate decisions, and seek guidance when needed, while supporting on-site facility operations and participating in Humana’s Tuberculosis (TB) screening program if selected for the role.