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

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

The Utilization Management Nurse 2 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.

Required Qualifications

  • Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action. Florida or compact license required.
  • This role is a 10 hour day 4 days a week position including Saturday and Sunday
  • 3 – 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience required
  • 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 have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

  • Previous experience in utilization management preferred
  • Education: BSN or Bachelor’s degree in a related field
  • Experience in utilization management or related activities reviewing criteria to ensure appropriateness of care preferred
  • MCG (Milliman) Criteria knowledge/experience preferred
  • Health Plan experience
  • Previous Medicare/Medicaid Experience a plus
  • Call center or triage experience
  • Bilingual is a plus English/Spanish

Additional Information

Hours for this role are: Friday, Saturday, Sunday, Monday – 10 hour shifts – 7am-5:30pm EST. Required: Florida RN License or Compact License

May require to work some holidays.

Scheduled Weekly Hours

40

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

Job Overview
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