Experienced Remote Utilization Management Nurse - Medicare - Southeast Region - Clinical Nursing Expertise in Utilization Review and Coordination

Join Our Team and Make a Difference in Healthcare

At Humana, we're committed to putting health first for our teammates, customers, and communities. As a Remote Utilization Management Nurse, you'll play a vital role in ensuring our members receive the best possible care and services. If you're passionate about delivering exceptional patient care and have a strong clinical background, we encourage you to apply for this exciting opportunity.

About the Role

The Utilization Management Nurse 2 is a key position that requires a strong and diverse skillset to drive success. As a remote employee, you'll have the flexibility to work from anywhere, but you'll need to be self-motivated and able to work independently with minimal direction. Your primary responsibilities will include:

• Utilizing clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
• Interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.
• Coordinating and communicating with providers, members, or other parties to facilitate optimal care and treatment.
• Assisting with social determinants and closing gaps in care to ensure our members receive comprehensive support.
• Understanding department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Making decisions regarding own work methods, occasionally in ambiguous situations, and requiring minimal direction and guidance where needed.
• FOLLOWING ESTABLISHED GUIDELINES/PROCEDURES.

Requirements

To be successful in this role, you'll need to possess the following qualifications:

• Licensed Registered Nurse (RN) with a compact license and no disciplinary action or in process of obtaining compact license.
• 3-5 years of clinical nursing experience, preferably in an emergency room or critical care setting.
• Prior clinical experience in an acute care, skilled, or rehabilitation clinical setting.
• Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
• Ability to work independently under general instructions and as part of a team.
• A high-speed DSL or cable modem for a home office, with a minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance.
• A passion for contributing to an organization focused on continuously improving consumer experiences.

Preferred Qualifications

We're looking for candidates with the following preferred qualifications:

• Education: BSN or Bachelor's degree in a related field.
• Health Plan experience.
• Experience in utilization management or related activities reviewing criteria to ensure appropriateness of care.
• Previous Medicare experience.
• Milliman MCG experience.

Work Environment and Culture

As a remote employee, you'll have the flexibility to work from anywhere, but you'll need to be self-motivated and able to work independently with minimal direction. Our company culture values personal identity protection, and we're committed to creating a safe and inclusive work environment for all employees.

Compensation and Benefits

We offer a competitive salary range of $69,800 - $96,200 per year, based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc. This role is eligible for a bonus incentive plan, based on company and/or individual performance. We also offer a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, company and personal holidays, volunteer time off, paid parental and caregiver leave, short-term and long-term disability, life insurance, and many other opportunities.

Career Growth Opportunities and Learning Benefits

We're committed to helping our employees grow and develop their careers. As a Remote Utilization Management Nurse, you'll have opportunities to learn and grow with our organization, including:

• Professional development and training programs.
• Mentorship and coaching opportunities.
• Networking opportunities with other healthcare professionals.
• Access to cutting-edge technology and tools.

How to Apply

If you're passionate about delivering exceptional patient care and have a strong clinical background, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and cover letter, through our website. We look forward to hearing from you!

We Encourage You to Apply!

Even if you feel you're not a perfect match, we'd still love to hear from you. We're looking for great people to join our friendly team, and we're committed to creating a diverse and inclusive work environment. Apply now and take the first step towards a rewarding career with Humana!