Overview 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 role requires interpretation and independent determination of the appropriate courses of action. As a Utilization Management RN on the OneHome/Home Solutions UM Team, you will use your clinical knowledge, communication skills, and independent critical thinking to ensure value-based care for members who desire to heal at home. You will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.
Responsibilities Coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.
Help ensure fully coordinated home care for members.
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 25 Mbps download x 10 Mbps upload
Check your internet speed at www.speedtest.net
A dedicated office space lacking ongoing 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. This is a remote position; occasional travel to Humana's offices for training or meetings may be required.
Pay Base pay range: $71,100.00/yr - $97,800.00/yr
OneHome provided pay range: This range is provided by OneHome. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description Of Benefits Humana offers competitive benefits that support whole-person well-being, including medical, dental and vision benefits, a 401(k) plan, paid time off and holidays, disability, life insurance, and other opportunities.
About Us About OneHome: OneHome coordinates a full range of post-acute care at patients’ homes. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive and caring, with a comprehensive benefits package for you and your family.
About Humana: Humana Inc. is committed to putting health first for teammates, customers, and the company, delivering care and service when needed across diverse populations.
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. We comply with Section 503 of the Rehabilitation Act and VEVRAA to employ and advance individuals with disabilities or protected veteran status, based on valid job requirements.