Utilization Management Nurse 2 - Humana Healthy Horizons in Ohio

Employment Type: Full-time

Position Overview

Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2. This role utilizes clinical nursing skills to support the coordination, documentation, and determination of medical services and/or benefit administration. The Utilization Management Nurse 2's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

About Humana

Become a part of our caring community at Humana. We are a hometown company proud of our Louisville roots, and as we've grown, that community feeling has spread across all 50 states and Puerto Rico. Whether you're working from home, the field, our offices, or somewhere in between, you'll feel welcome. We are a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone's voice is heard and respected. Community is a verb here; it’s up to each of us to care for it and maintain it, as the relationships we form help us deliver better health outcomes for the people we proudly serve.

Responsibilities

The Utilization Management Nurse 2 will:

• Use clinical knowledge, communication skills, and independent critical thinking skills to interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Make decisions regarding own work methods, occasionally in ambiguous situations, requiring minimal direction and receiving guidance where needed.
• Follow established guidelines/procedures.

Requirements

Required Qualifications:

• Licensed Registered Nurse (RN) with no disciplinary action.
• 3-5 years of Medical Surgery, Heart, Lung, or Critical Care Nursing experience.
• Previous experience in utilization management.
• Prior clinical experience, preferably in an acute care, skilled, or rehabilitation clinical setting.
• Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
• Ability to work independently under general instructions and with a team.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Preferred Qualifications:

• Bachelor's degree.
• Health Plan experience.
• Previous Medicare/Medicaid Experience is a plus.
• Call center or triage experience.
• Bilingual skills are a plus.

Additional Information

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.

Internet Service Requirements for Remote Employees:

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps.
• Wireless, wired cable, or DSL connection is suggested.
• Satellite, cellular, and microwave connections may be used only if approved by leadership.
• Employees residing in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for internet expenses.

Humana will provide Home or Hybrid Home/Office employees with appropriate telephone equipment to meet business requirements. Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:

• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.