Utilization Management Nurse - Broward and Palm Beach Counties FL

Profile

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 Florida with no disciplinary action.
Minimum of 2 years clinical experience in an acute setting
Prior experience with Utilization Review/discharge planning OR Case Management Experience
Prior experience using MCG Guidelines OR Interqual criteria
Excellent computer skills and ability to navigate easily using multiple applications
Proficiency with MS Office Suite, Excel, Word, Outlook
Ability to work independently under general instructions and with a team


Additional Requirements


Hours: Monday -Friday 8 am- 5 pm EST and be flexible due to the business needs
Work style: This position is considered primarily remote/work at home
Location: Broward and Palm Beach Counties
Travel: 50% onsite facility visits and/or to market offices for business needs (See Additional Information)


Remote Work at Home Requirements (See Additional Information)


Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet services NOT allowed for this role)
A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required


Transportation


Possession of a valid driver's license and access to a reliable automobile
This role is part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.


TB and AHCA


This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you may be required to be screened for TB.
AHCA Fingerprint Required.


Preferred Qualifications


Utilization Management
Coding experience
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Bilingual is a plus


Additional Information:

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Interview Process

As a part of our hiring process for this opportunity, we will be using a technology called Modern Hire Text interview which allows us to quickly connect and gain valuable information from you about your relevant experience.

If you are selected for a phone screen, you will receive an email inviting you to participate in the Modern Hire Text Interview. During this call, you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for a person or video interview, depending on your location.

Scheduled Weekly Hours

40

Company info

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