Weekend Telephonic Utilization Management Nurse - Remote (AZ, CO, NM)
Humana

Job Info

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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 (AZ, CO, NM) with no disciplinary action
• 3-5 years of acute care experience in a hospital 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
• Must reside in Pacific or Mountain Standard Time Zones

Preferred Qualifications

• Education: BSN or Bachelor's degree in a related field
• 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 licensure a plus
• Bilingual a plus

Additional Information

• Work Schedule and Hours for this weekend role are: Flexible: either four 10 hr shifts, or five 8hr shifts. Every other Saturday required.

Scheduled Weekly Hours

40

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