Join to apply for the SNF Utilization Management RN - Compact Rqd role at OneHome
This range is provided by OneHome. 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
Overview 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 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.
Responsibilities Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
Interpret criteria, policies, and procedures to determine the most appropriate treatment, care, or services for members.
Utilize clinical nursing skills to support utilization management/benefit administration determinations.
Work independently under general instructions and with a team; make decisions regarding own work methods, including in ambiguous situations.
Follow established guidelines and procedures.
Required Qualifications Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action.
Must have Compact License.
Greater than one year of clinical experience as an RN in an acute care setting; preference for critical care, emergency, trauma, 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 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 (CA, HI, NV, OR).
Health Plan experience; Medicare/Medicaid experience a plus.
Call center or triage experience; bilingual is a plus.
Additional Information Scheduled Weekly Hours: 40
Travel: Remote position with occasional travel to Humana's offices for training or meetings may be required.
Work-At-Home Requirements Must provide a high-speed DSL or cable modem for a home office (Satellite/Wireless internet is not allowed).
Minimum speed: 25 Mbps download x 10 Mbps upload.
Check internet speed at speedtest.net.
A dedicated office space free of interruptions to protect member PHI/HIPAA information.
Pay Range The pay range reflects a good faith estimate of starting base pay for full-time employment. Pay may vary by location and individual qualifications.
Estimated Pay: $71,100 - $97,800 per year.
Description Of Benefits Humana offers competitive benefits to support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings, paid time off and holidays, disability coverage, life insurance, and other opportunities.
About Us About OneHome: OneHome coordinates post-acute care from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient-focused model creates an integrated point of accountability 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. We are inclusive and caring and offer a comprehensive benefits package.
About Humana: Humana Inc. is committed to putting health first for teammates and customers. Through Humana insurance services and CenterWell healthcare services, we aim to help people achieve their best health and quality of life.
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 is an equal opportunity employer and complies with applicable laws and regulations.
Additional information: Seniority level – Mid-Senior level; Employment type – Full-time; Job function – Health Care Provider; Industries – Hospitals and Health Care.