Utilization Management Nurse (Midwest Region)

Become a part of our caring community and help us put health first 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. Creating Healthy Communities is good for the Soul. Join Us! 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 appropriate discharge planning including to assist with social determinants and closing gaps ? Review UM inpatient admission and clinical information to determine appropriate level of care ? 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 Use your skills to make an impact Required Qualifications ? Licensed Registered Nurse (RN) in KY, IN, MI, OH or WV with no disciplinary action ? 3 years of prior clinical experience preferably in an acute care hospital setting ? Comprehensive knowledge of Microsoft Word, Outlook and Excel ? Excellent communication skills both verbal and written ? 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 Preferred Qualifications ? Bachelor's degree in nursing (BSN) ? Health Plan experience ? Previous Medicare experience a plus ? Utilization Management experience ? Milliman/MCG experience Work-At-Home Requirements To ensure Home or Hybrid Home/Office associates? ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: ? At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested ? Satellite, cellular and microwave connection can be used only if approved by leadership ? Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense ? Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job ? Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Additional Information ? Hours are Monday-Friday 10am-7pm EST Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $69,800 - $96,200 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, ?Humana?) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first ? for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health ? delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of ?Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of ?Humana?to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment Apply Job! 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