Home Health Utilization Management Nurse

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/Home Health Utilization Management:

• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Provider facing phone calls
• Review cases using 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.

Required Qualifications

• Clinical experience in Medicare Home Health (in the last 12 months)
• 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
• Licensed Registered Nurse (RN) in the state appropriate(s) with no disciplinary action
• Comprehensive knowledge of Microsoft Word, Outlook and Excel

Preferred Qualifications

• Previous Medicare/Medicaid Experience a plus
• Previous experience in Case Management, Discharge Planning or Utilization Management
• Bachelor's degree in nursing (BSN)
• Health Plan experience
• Bilingual is a plus

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:

• Satellite, cellular and microwave connection can be used only if approved by leadership
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
• 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
• 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

Additional Information

• Work Hours Monday-Friday 8am-5pm EST/CST, hours subject to change based on business needs
• This is a remote position

#LI-Remote

Scheduled Weekly Hours

40