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Kentucky, United States
Remote only
The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members.
Success in this role requires the following:
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Excellent organizational and time management skills
• Solid analytical skills to understand and interpret clinical information to make recommendations to improve patient outcomes.
• Technical savvy and ability to navigate multiple systems and screens while working cases.
• Collaboration skills to effectively interact with multiple parties both internal and external.
• An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed.
• Ability to follow established guidelines, processes, and procedures.
Shift is Monday - Friday 8:00am - 5:00pm Eastern Standard Time
Required Qualifications
• Minimum of Associate Degree in nursing
• Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
• Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
• Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population
• Effective telephonic and virtual communication skills
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Ability to work independently under general instructions and within a team.
Preferred Qualifications
• Bachelor’s degree
• Two (2) or more years of home health experience and/or utilization management experience
• Experience in a managed care setting
• Health Plan experience
• CGX experience
Work-At-Home Requirements
• 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 is 25mbs download x 10mbs upload is required.
• Check your internet speed at www.speedtest.net
• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Florida Background Screening Requirements: Notice for candidates applying to this position from a Florida work location, including Florida home-based work location. This position is subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse. For information about the screening process and requirements, visit: https://info.flclearinghouse.com.
Scheduled Weekly Hours
40Pay 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.
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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.