Utilization Management Nurse
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Job Description
Utilization Management Nurse coordinating medical services and benefit determinations for Humana, a U.S. healthcare and insurance company. Applying clinical criteria to support optimal member care.
Responsibilities:
- Utilize clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations
- Interpret clinical criteria, policies and procedures to provide appropriate treatment, care or services for members
- Coordinate and communicate with providers, members and other parties to facilitate optimal care and treatment
- Apply clinical knowledge, communication skills and independent critical thinking
- Make independent decisions regarding work methods and courses of action
- Follow established guidelines and procedures
- Work with minimal direction and seek guidance when needed
Requirements:
- Licensed Registered Nurse (RN) (Compact License) with no disciplinary action
- Bachelor's degree
- 3–5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
- 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
- Ability to work the eastern or central time zone
- Home internet with at least 25 Mbps download and 10 Mbps upload speed
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
Benefits:
- Bonus incentive plan based upon company and/or individual performance
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Other whole-person wellness and healthcare opportunities
- Remote work arrangement
- Occasional travel to Humana offices for training or meetings
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