Overview Utilization Management Nurse - Home Solutions (Compact RN Required) role at OneHome. This is a full-time, remote telephonic opportunity. The OMN uses clinical nursing skills to support coordination, documentation, and communication of medical services and/or benefit administration determinations. The role requires interpretation and independent determination of appropriate action and aims to ensure value-based care for members who desire to heal at home.
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.
Apply clinical knowledge, communication skills, and independent critical thinking to ensure value-based care.
Support the coordination, documentation, and communication of medical services and/or benefit determinations.
Interpret and determine appropriate courses of action within established guidelines and processes.
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 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 and technical 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
A dedicated office space with minimal interruptions to meet productivity requirements and protect member PHI/HIPAA information
Schedule and travel Shift is Monday - Friday 8:00am - 5:00pm Eastern Standard Time. Travel to Humana offices for training or meetings may be required occasionally.
Benefits and compensation This job is eligible for a bonus incentive plan. Humana offers competitive benefits including medical, dental, and vision coverage, 401(k) retirement savings, paid time off, holidays, volunteer time off, parental and caregiver leave, disability and life insurance, and other opportunities.
About Us About OneHome: OneHome coordinates a full range of post-acute care at patients’ homes, creating an integrated point of accountability with physicians, hospitals, and health plans serving members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care.
About Humana: Humana is committed to putting health first by delivering care and services when needed, including CenterWell and related services, to support millions of people in various programs and communities.
Equal Opportunity Employer Humana is an equal opportunity employer. It does not discriminate against applicants for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. It also affirms actions in compliance with applicable laws to employ and advance individuals with disabilities or protected veteran status.