RN Telephonic Utilization Management Nurse 2 - Metairie, LA or Baton Rouge, LA (Office Based)
Humana

Metairie, Louisiana

Posted in Insurance
10 days ago


Job Info


Description

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.

Responsibilities

The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

  • Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action.
  • 3-5 years of acute and critical care clinical experience
  • Comprehensive knowledge of Microsoft Word, Outlook and Excel with the ability to type and enter data accurately
  • Ability to work independently under general instructions and with a team
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • 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 of 10x1 (10mbs download x 1mbs upload) is required
Preferred Qualifications
  • Education: BSN or Bachelor's degree in a related field
  • Previous experience in utilization management
  • Health Plan experience
  • Previous Medicare/Medicaid Experience a plus
  • Call center or triage experience
  • Bilingual is a plus
Additional Information
  • Hours for this role are: Monday-Friday, 8am-5pm CST
  • This is an office based role in Metairie or Baton Rouge, LA. (Currently this role is full time work at home due to COVID-19 and will remain so until it is considered safe for associates to return to normal business operations)
Scheduled Weekly Hours

40



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