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 nurse uses clinical knowledge, communication skills, and independent critical thinking 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
Apply utilization management and clinical nursing skills to coordinate, document, and communicate medical services and benefit determinations.
Interprets criteria, policies, and procedures to provide appropriate treatment, care or services for members.
Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment.
Align work with department, segment, and organizational strategy and operating objectives.
Work independently under general instructions and with a team; adapt to ambiguous situations with minimal direction.
Follow established guidelines and procedures.
Qualifications
Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action.
Compact License is required.
Greater than one year of clinical experience in an RN role in an acute care setting; preference for critical care, emergency, trauma, etc.
Proficiency in Microsoft Word, Outlook and Excel.
Ability to work independently and as part of a team.
Passionate about 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 (preference for critical care, emergency room, trauma units).
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: This is a remote position; occasional travel to Humana's offices for training or meetings may be required.
Work-At-Home Requirements
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).
A minimum standard speed of 25 Mbps download x 10 Mbps upload is required.
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 employment at the time of posting. Pay may vary by geographic location and individual skills and experience. Humana offers competitive benefits including medical, dental, vision, 401(k), paid time off, disability, life insurance, and other opportunities.
About Us
About OneHome: OneHome coordinates a full range of post-acute care in patients’ homes. OneHome’s patient-focused model creates one integrated point of accountability. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and caring, with comprehensive benefits to support health and financial well-being.
About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first and making it easier for the millions we serve to achieve their best health.
Equal Opportunity Employer
Humana does not discriminate against any employee or applicant for employment based on 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.