Utilization Management Nurse 2

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.

Core hours for this role are 7:00 a.m. to 5 p.m. CST – specific hours and scheduling will be determined during training and by leader. Occasionally, weekend work may be required to help support business needs. Additional information will be provided during the interview process.

Skills

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. Utilization Management Nurse 2 will collaborate with other health care providers in reviewing actual and proposed medical care and services against established CMS and Humana Medical coverage guidelines. This is a utilization management position. In this role you will:

Complete clinical review of cases by reviewing medical records and applying appropriate criteria. Utilize Clinical knowledge to determine if medical appropriateness has been met, and if not, collaborate with Regional Medical Directors to complete review. Manage case reviews keeping compliance, quality and productivity in mind. Participate in special projects/ stretch assignments as assigned by the Clinical Review Team, Front Line LeaderCore hours for this role are 7:00 a.m. to 5 p.m. CST – specific hours and scheduling will be determined during training and by leader.This position is WAH but it is a requirement for associate to reside in the state of Indiana. No travel required.

Role Essentials

Use your skills to make an impact

Active RN License in the state of INCurrent residence in the state of IN3 years of prior clinical experience as a RNThe ability to work from home in a dedicated officeProven ability working independently: (ie: taking initiative to utilizing resources to enable decision making)Computer proficiency: comfortable working with and on computers as well as within multiple systems simultaneously, including efficient in use of Microsoft products (i.e. Word, Excel, etc.)Strong verbal and written communication skills

Role Desirables

Outpatient or inpatient Utilization Management experienceHealth Plan/Insurance experienceExperience with Medicare/Medicaid regulationsBSN or Bachelor’s degree in a related fieldExperience working in a virtual environmentBilingual in Spanish/English is a plus

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipAssociates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information

Workstyle: Remote/work from homeCore Workdays & Hours: Monday – Friday; 7am-5pm CSTBenefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes; 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance, extensive PTO and much more.....

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$69,800 - $96,200 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.