Humana · 13 hours ago

RN - Utilization Management

Remote Florida

Full-time

Remote

Mid Level

$71K/yr - $98K/yr

3+ years exp

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Responsibilities

Utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.

Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Registered Nurse (RN)Medical Surgery experienceCritical Care Nursing experienceUtilization Management experienceHeart Nursing experienceLung Nursing experienceAcute care experienceBSNHealth Plan experienceSkilled care experienceRehabilitation clinical experienceMicrosoft WordMicrosoft OutlookMicrosoft ExcelMedicare experienceMedicaid experienceCall center experienceTriage experienceBilingual

Required

Must Reside and have an RN license in the State of Florida

Bachelor's degree

Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action.

This is a fully remote permit 10-hour shift weekend position (Thurs-Sun) - must be able to accommodate this schedule.

This role is considered patient facing and is part of Humana/Senior Bridge's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience required

Previous experience in utilization management required

Prior clinical experience preferably 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 with a team

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

Must be passionate about contributing to an organization focused on continuously improving consumer experiences