Humana (501+ Employees, 13% 2 Yr Employee Growth Rate)

4% 1-Year Employee Growth Rate | 13% 2-Year Employee Growth Rate | LinkedIn | $750M Venture Funding

What Is Employee Growth Rate & Why Is It Important?

Description

Utilization Management Nurse – Weekend Front End Review 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.

4 X 10’s Thursday- Sunday, 7am-6pm

How we Value You
Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being

Responsibilities

The Utilization Management Nurse – Weekend Front End Review 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.

  • Utilize MCG criteria to perform acute concurrent front end reviews on Humana members to determine medical necessity.

Must be willing to compy with the following:

  • Florida RN license
  • Availability to work a Weekend Schedule every weekend. With a schedule of Saturday-Tuesday each week.
  • 4 X 10’s Sunday, Monday, Tuesday, Saturday 7:00 AM to 6:00 PM

Required Qualifications

  • Licensed Registered Nurse (RN) in Florida with no disciplinary action.
  • 3 or more years experience preferably in an acute care- inpatient hospital setting.
  • Intermediate or better working using 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
  • Strong general computer skills in an autonomous work setting.

Additional Requirements/Adherence

Workstyle: Remote Work at Home

Location: Supporting Florida Market

Hours:

  • Availability to work a Weekend Schedule every weekend. With a schedule of Saturday-Tuesday each week.
  • 4 X 10’s Sunday, Monday, Tuesday, Saturday 7:00 AM to 6:00 PM

Travel: None

Work-At-Home Requirements

  • WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
  • A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  • Satellite and Wireless Internet service is NOT allowed for this role.
  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

  • Bachelor’s degree
  • Front End Review experience
  • Previous experience in Utilization Management
  • CGX experience
  • MCG experience
  • Health Plan experience
  • Previous Medicare/Medicaid Experience

Additional Information

Covid Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Tagged as: 501+ Employees, Hide US-Only Jobs, Venture Funded

Job Overview
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