Utilization Management Nurse 2 - Onsite/Hybrid

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

This specific Onsite/Hybrid position is located at the Camden Clark Medical Center in Parkersburg, West Virginia. The Utilization Management Nurse 2 will support the coordination, documentation, and communication of medical services, discharges, and/or benefit administration determinations. This role involves working at an onsite facility with limited hours working from home at the leader’s discretion.

The ideal candidate must be located within a 1-hour driving distance to the Onsite location.

Requirements

• RN License: Must possess a current, unrestricted RN license in the state of West Virginia or a Compact state license.
• Location: Must be located within a 1-hour driving distance to Camden Clark Medical Center from your home base.
• Clinical Experience: 2 or more years of clinical experience, preferably in an adult/geriatric acute care, skilled, or rehabilitation clinical setting.
• Software Proficiency: Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
• Work Style: Ability to work independently under general instructions and collaboratively within a team.
• Critical Thinking: Independent critical thinking skills are essential.
• Communication Skills: Strong written and verbal communication skills.
• Driver's License/Transportation: Valid Driver's License and/or dependable transportation is necessary for travel to hospitals/providers for onsite reviews.
• Patient Facing: This role is considered patient-facing. If selected, you will be required to meet criteria to be onsite with Providers/Hospitals/Health Care Facilities.

Responsibilities

• Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services, discharges, and/or benefit administration determinations.
• Interpret clinical information and make independent determinations regarding appropriate courses of action.
• Travel to hospitals/providers for onsite reviews to assist Members.
• Work at an onsite facility with limited hours working from home at the leader’s discretion.

Preferred Qualifications

• Education: Bachelor's degree in nursing (BSN).
• Experience: Previous experience in discharge planning, utilization management, or case management is a plus.
• Health Plan Experience: Previous health plan experience is preferred.
• Medicare/Geriatric Experience: Previous Medicare/Geriatric experience is a plus.
• Bilingual: Bilingual skills are a plus.

Work-At-Home Requirements

To ensure effective work from home or hybrid home/office, your self-provided internet service must meet the following criteria:

• Speed: Minimum download speed of 25 Mbps and upload speed of 10 Mbps recommended.
• Connection Type: Wireless, wired cable, or DSL connection is suggested. Satellite, cellular, and microwave connections may be used only if approved by leadership.
• Internet Expense (Specific States): Associates living and working from home in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Telephone Equipment: Humana will provide telephone equipment appropriate to meet the business requirements for the position.
• Work Environment: Work from a dedicated space lacking ongoing interruptions to protect member Protected Health Information (PHI) / HIPAA information.

Additional Information

• Scheduled Weekly Hours: 40 hours per week.
• Shift: Must be able to work 8:00 am - 5:00 pm EST, Monday through Friday.
• Travel: While this is a hybrid position, occasional travel to Humana's offices for training or meetings may be required.
• Pay Range: The compensation range reflects a good faith estimate of starting base pay. Actual pay will vary based on geographic location and demonstrated job-related skills and experience.