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 role works on the OneHome/Home Solutions UM Team to ensure value-based care for members who desire to heal at home. The position is full-time and remote telephonic.
Base pay range: $71,100.00/yr - $97,800.00/yr
Responsibilities Coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.
Use clinical knowledge, communication skills, and independent critical thinking to determine appropriate courses of action in varied assignments.
Support the coordination, documentation and communication of medical services and benefit administration determinations.
Required Qualifications Minimum of Associate Degree in nursing
Licensed Registered Nurse (RN) in a compact state with no disciplinary action
Valid compact license or reside in a compact state and be eligible to upgrade to compact licensure
Three (3) or more years of progressive and varying clinical experience including direct patient care to geriatric population
Effective telephonic and virtual communication skills
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and within a team
Preferred Qualifications Bachelor’s degree
Two (2) or more years of home health experience and/or utilization management experience
Experience in a managed care setting
Health Plan experience
CGX experience
Work-From-Home & Location 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 for this role).
A minimum standard speed of 25 Mbps download x 10 Mbps upload is required.
Check your internet speed at www.speedtest.net
A dedicated office space lacking ongoing interruptions to meet productivity requirements and to protect member PHI / HIPAA information.
Schedule Shift is Monday - Friday 8:00am - 5:00pm Eastern Standard Time. 40 hours per week.
Travel Remote position with occasional travel to Humana's offices for training or meetings may be required.
Benefits & About Us Pay range note: 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. This job is eligible for a bonus incentive plan.
Humana offers competitive benefits: medical, dental and vision benefits, 401(k) retirement savings plan, time off (paid time off, holidays, volunteer time off, paid parental and caregiver leave), disability, life insurance, and more. About OneHome: OneHome coordinates a full range of post-acute care services and was acquired by Humana in 2021. About Humana: Humana is committed to putting health first for teammates, customers, and the company.
Equal Opportunity Employer: Humana does not discriminate against any employee or applicant for employment and complies with applicable laws and regulations related to job opportunities and affirmative action.