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 involves interpretation and independent determination of appropriate courses of action, with opportunities to use clinical knowledge, communication skills, and independent critical thinking to ensure value-based care for members who desire to heal at home. The position is full-time, remote telephonic.
Responsibilities Coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.
Apply clinical knowledge to support coordination, documentation, and communication of medical services and benefit determinations.
Make independent determinations of appropriate actions within established guidelines and processes.
Qualifications 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 Location and Schedule Work location: Remote. Shift is Monday - Friday 8:00am - 5:00pm Eastern Standard Time. Travel to Humana offices for training or meetings may be required occasionally.
Pay and Benefits 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.
Schedule: 40 hours per week.
About Us About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services 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. Our culture is inclusive, diverse, and above all, caring.
About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through Humana insurance services and CenterWell healthcare services, we make it easier for the millions we serve to achieve their best health.
Equal Opportunity Employer It is the policy of Humana not to 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. Humana also uses affirmative action in compliance with applicable laws.