Overview This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $71,100.00/yr - $97,800.00/yr
Role summary The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The nurse uses clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures to provide 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 follows established guidelines/procedures.
Responsibilities Provide utilization management support through interpretation of criteria, policies and procedures.
Coordinate and communicate with providers, members, and other stakeholders to facilitate optimal care.
Apply clinical knowledge and critical thinking to determine appropriate actions.
Work independently under general instructions and with a team.
Required qualifications Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action.
Compact license required.
Greater than one year of clinical experience in an RN role in an acute care setting; preference for specialties such as 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.
Passionate about contributing to an organization focused on continuously improving consumer experiences.
Preferred qualifications BSN or related Bachelor's degree.
Three or more years of clinical experience in an acute care setting (preferred in critical care, ED, 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 (CA, HI, NV, OR).
Health plan experience; Medicare/Medicaid experience is a plus.
Call center or triage experience; bilingual skills a plus.
Additional information Scheduled Weekly Hours: 40
Travel: Remote position with occasional travel to Humana offices for training or meetings as required.
Work-From-Home requirements: Must have a dedicated home office with high-speed internet; minimum 25 Mbps download / 10 Mbps upload; satellite or wireless internet not allowed; uninterrupted space to protect PHI/HIPAA information.
Pay and benefits The compensation range reflects a good faith estimate for full-time employment at posting. Actual pay may vary by location and candidate experience.
Benefits include medical, dental, vision, 401(k), paid leave, disability, life insurance, and other opportunities.
About Us About OneHome: OneHome coordinates post-acute care including home health, infusion therapy and durable medical equipment at patients’ homes. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and caring. We offer a comprehensive benefits package to support health and financial well-being.
About Humana: Humana Inc. (NYSE: HUM) provides health insurance services and CenterWell healthcare services to help people achieve their best health, delivering care when needed.
Equal Opportunity Employer Humana does not discriminate on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. We comply with applicable laws and policies to employ and advance individuals based on valid job requirements.