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. 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.
• 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.

Requirements

• Location Type: Remote Work At Home
• Employment Type: Full-time
• Required Qualifications:
  • Must reside in Indiana.
  • Licensed Registered Nurse in the state of Indiana without restrictions or disciplinary actions.
  • 3+ years of Medical Surgery, Heart, Lung, Emergency Room, or Critical Care Nursing experience.
  • Working knowledge of MS Office including Word, Excel, PowerPoint, and Teams in a Windows-based environment.
  • Ability to quickly learn new systems and troubleshoot basic technical difficulties in a remote environment.
  • Ability to work independently under general instructions and with a team.
• Preferred Qualifications:
  • Bachelor's degree.
  • Previous experience in utilization management, case management, discharge planning, and/or home health, rehab, or behavioral health.
  • Managed Care / Health Plan experience.
  • Previous Medicare/Medicaid Experience.
  • Experience working with MCG or Interqual guidelines.
  • Working knowledge using the following systems/platforms: CGX, MHK, Maccess, CAS.
  • Bilingual skills.

Work Environment & Schedule

• Workstyle: Remote Work At Home
• Training Schedule: Monday - Friday; 8:00 am - 5:00 pm EST
• Schedule: Monday - Friday 8:00 am - 5:00 pm EST; overtime and weekends may be requested to meet business needs.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Internet Requirements: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable, or DSL connection is suggested. Satellite, cellular, and microwave connections can be used only if approved by leadership. Employees in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Equipment: Humana will provide home or hybrid home/office employees with telephone equipment appropriate to meet business requirements.

Travel

• Travel: Must be willing to commute about 5-10% to meet with providers or staff meetings. More information will be provided during the interview.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Compensation & Benefits

• Pay Range: $71,100 - $97,800 per year (This is a good faith estimate of starting base pay for full-time employment. Actual pay may vary based on location, skills, knowledge, experience, education, and certifications.)
• Bonus: This job is eligible for a bonus incentive plan based on company and/or individual performance.
• Benefits: Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being.

Company Information

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”)