Join to apply for the Utilization Management Nurse - Home Solutions - Compact RN Required role at OneHome
Base pay range
$71,100.00/yr - $97,800.00/yr
Become a part of our caring community and help us put health first - Full-Time, Remote Telephonic opportunity
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. As a Utilization Management RN working on the OneHome/Home Solutions UM Team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal at home. In this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.
Role
The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Success in this role requires the following:
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Excellent organizational and time management skills
Solid analytical skills to understand and interpret clinical information to make recommendations to improve patient outcomes.
Technical savvy and ability to navigate multiple systems and screens while working cases.
Collaboration skills to effectively interact with multiple parties both internal and external.
Understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed.
Ability to follow established guidelines, processes, and procedures.
What You’ll Do
Shift is Monday - Friday 8:00am - 5:00pm Eastern Standard Time
Required Qualifications
Minimum of Associate Degree in nursing
Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
Must have 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 that includes 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-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 for this role).
A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.
Check your internet speed at www.speedtest.net
A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information
Travel: While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required.
40
Pay Range
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.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description Of Benefits
Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being. Benefits include medical, dental and vision benefits, 401(k) retirement savings, time off (paid time off, holidays, volunteer time off, parental and caregiver leave), disability, life insurance and more.
About Us
About OneHome: OneHome coordinates a full range of post-acute care 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.
About Humana: Humana is committed to putting health first and delivering care and service when you need it.
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 and complies with applicable laws.