Post Acute Telephonic Utilization Management Nurse - Work at Home AZ CO NM

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Description

The Post Acute 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 Post Acute 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 at the acute rehab and long term care hospital level of care. 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): licensure required in all 3 states, AZ, CO, NM or your licensure must be part of a compact with no disciplinary action
Prior clinical experience preferably in a post-acute, skilled or rehabilitation clinical setting
Must have good typing skills and proficiency using MS Office Word, Excel and Outlook
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
2 years previous experience in acute care rehab and/or LTACH care
Utilization management preferred
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Experience working with CMS guidelines a plus
Call center or triage experience


Additional Information


Hours for this role are: Monday-Friday, 8am-5pm MST with a weekend rotation.
The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective April 1, 2011, Humana has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.


Scheduled Weekly Hours

40

Company info

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