Overview Join to apply for the SNF Utilization Management RN - Compact Rqd role at OneHome .
Base pay range: $71,100.00/yr - $97,800.00/yr
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. The role uses clinical knowledge, communication skills, and independent critical thinking to interpret 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.
Responsibilities Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
Analyze and interpret criteria, policies, and procedures to determine appropriate medical services or benefit determinations.
Apply clinical knowledge and critical thinking to support utilization management activities in a health plan or acute care setting.
Work independently under general instructions and with a team; take initiative in ambiguous situations while adhering to guidelines.
Required Qualifications Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action.
Compact License (MUST have Compact License).
Greater than one year of clinical experience as an RN in an acute care setting; preference for critical care, emergency room, trauma units, etc.
Comprehensive knowledge of Microsoft Word, Outlook and Excel.
Ability to work independently under general instructions and with a team.
Passion for contributing to an organization focused on continuously improving consumer experiences.
Preferred Qualifications Education: BSN or Bachelor's degree in a related field.
Three or more years of clinical experience in an acute care setting (critical care, emergency, trauma, etc.).
Experience as an MDS Coordinator or discharge planner in an acute care setting.
Experience in utilization management/utilization review for a health plan or acute care setting.
Compact license plus a single state RN licensure in non-compact states: California, Hawaii, Nevada, Oregon.
Health plan experience; Medicare/Medicaid experience a plus.
Call center or triage experience; bilingual is a plus.
Additional Information Scheduled Weekly Hours: 40
Travel: This is a remote position; occasional travel to Humana’s offices for training or meetings may be required.
Work-At-Home Requirements Must provide high-speed DSL or cable modem for a home office; satellite and wireless internet service is not allowed for this role.
Minimum standard speed: 25 Mbps download x 10 Mbps upload.
Check internet speed at www.speedtest.net.
Dedicated office space with minimal interruptions to protect member PHI/HIPAA information.
Pay and Benefits The compensation range reflects a good faith estimate of starting base pay for full-time (40 hours/week) at the time of posting. Pay may vary by geographic location and individual factors such as skills, experience, and certifications. Description of benefits includes medical, dental, vision, 401(k), paid time off, holidays, parental and caregiver leave, disability, life insurance, and other opportunities.
About Us About OneHome: OneHome coordinates a full range of post-acute care from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient-focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and caring, and we offer a comprehensive benefits package to support health and financial well-being.
About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, we aim to make it easier for the millions we serve to achieve their best health, delivering care when needed. These efforts support better quality of life for people in Medicare, Medicaid, families, individuals, military personnel, and communities.
Equal Opportunity Employer Humana does not 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 protected veteran status. Humana also takes affirmative action to employ and advance individuals with disability or protected veteran status in compliance with applicable laws.