RN Utilization Management Nurse - Home Health Experience Required
Humana

Brentwood, Tennessee

Posted in Insurance
15 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 state of TN and AL with no disciplinary action or compact license covering these locations
  • 1 year or more of recent clinical experience in Medicare Home Health is required
  • Comprehensive knowledge of MicrosoftWord, Outlook and Excel
  • 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 case management, discharge planning or utilization management experience preferred
  • MCG or Interqual experience
  • Health Plan experience
  • Previous Medicare/Medicaid Experience a plus
  • Call center or triage experience
  • Bilingual is a plus
Scheduled Weekly Hours

40



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