RN - Telephonic Utilization Management Nurse - Acute Care - Remote Tn/Al Or Compact License

Humana Inc. Birmingham , AL 35202

Posted 4 weeks ago

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

  • Unrestricted Licensed Registered Nurse (RN) in Tennessee and Alabama with no disciplinary action.

  • 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing experience

  • Comprehensive knowledge of Microsoft Word, Outlook and Excel

  • 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 be available to work Monday-Friday 8am-5pm CST or EST or 9am-6pm CST or EST

Preferred Qualification

  • Bachelor's degree in Nursing

  • Previous experience in utilization management

  • Health Plan experience

  • Previous Medicare/Medicaid Experience

  • Triage experience

  • Bilingual

Additional Requirements - Work At Home

  • Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.

  • 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.

Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

BE SURE TO CHECK JUNK/SPAM FOLDER SO YOU DO NOT MISS THE EMAIL

Scheduled Weekly Hours

40

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Acute Dialysis RN Nocturnal

Davita

Posted 1 week ago

VIEW JOBS 10/13/2021 12:00:00 AM 2022-01-11T00:00 620 S 19TH ST ROOM W807UAB HOSPITAL SPAIN-WALLACE BUILDING, BIRMINGHAM, Alabama, 35233-1925, United States of AmericaDaVita is seeking a *Registered Nurse* who is looking to give life to patients in an Acute Hospital setting. RNs in this role work autonomously alongside the hospital staff to assess, troubleshoot, and make sound decisions for the critically ill patients. If you haven't considered Nephrology nursing before, read on as we think that you should. Dialysis Experience is NOT required. * What you can expect:* * *Use your critical care thinking skills. *Whether this is the first or a blip in their chronic treatment, our RNs are experts in educating our patients and families. You'll be able to leverage your nursing skills for patients who are often dealing with multiple co-morbidities and/or acute conditions which require unique treatment plans and the ability to leverage a broad range of nursing skills and knowledge. * *Not just hemodialysis. *Acute RNs may deliver nephrology care across multiple renal therapies: peritoneal, continuous renal replacement and apheresis. * *Autonomy in a hospital setting. *Deliver dialysis to patients at a particular hospital or group of hospitals and become an integral part of their team and ours. As a teammate in an acute setting you work on your own almost all of the time. Each day you assess, troubleshoot, and make sound decisions for critical patients. Our Hospital Services group performs 1.1M treatments annually. * *Dynamic environment.* No two days are ever the same for an acute dialysis nurse. You'll work within a variety of settings (ICU, CCU, ER and more), and you'll be able to keep learning new nursing skills on top of dialysis. * *Schedule:* Provide emergent, lifesaving care during on call shifts. Schedules vary by hospital system. For this role expect to know your weekly schedule in advance, but your daily schedule may change depending on patient needs. Must be in commutable distance based on on-call requirements. * *The Gold Seal*. As an Ambulatory Health Care accredited provider, DaVita is following and meeting the highest standards of care, providing care in line with the highest industry standards according to The Joint Commission. We expect our nurses to commit to improving patient health through clinical goal setting and quality improvement initiatives. Some additional details about this position: * Training may take place in a facility or a training clinic with a class of new teammates other than your assigned home clinic * Hours of work may vary during the training period; however, you will typically be working between 32-40 hours per week during training * You must have a flexible schedule and be able to work mornings, evenings, weekends, and holiday * You Must Have (aka. Requirements):* * Current and valid Registered Nurse (RN) license in the state where practicing * Willingness to work a flexible schedule with mandatory overtime required due to the nature of the acute treatment you are providing. * Work long days without notice * Ability to travel to multiple hospitals within a given area (Be sure to ask your recruiter about the commute range for this position.) * Experience assessing, trouble shooting and making sound recommendations in stressful situations * Physical Requirement: nurses often have to push/pull large hemodialysis machines around the hospital with little or no assistance * Associates Degree in Nursing (A.D.N) from accredited school of nursing required; Bachelor of Science in Nursing (B.S.N); three-year diploma from accredited diploma program may be substituted for nursing degree * Basic computer skills and proficiency in MS Word and Outlook * You might also have (a.k.a. preferred, not required):* * Hemodialysis nursing experience in an acute or chronic setting * Medical/surgical (Med/Surg), Intensive Care Unit (ICU), Critical Care Unit (CCU), and/or Emergency Room (ER) experience * Certified Nephrology Nurse (CNN), Certified Dialysis Nurse (CDN) and/or Certified Hemodialysis Nurse (CHN) Nurses: if this isn't the job for you, perhaps you have a friend who would be a perfect fit. Send them this link. Questions? Email us at [careers@davita.com](mailto:careers@davita.com) or send us a message on our DaVita Careers Facebook page. DaVita is an equal opportunity employer - Vet and Disability. To learn more about what this means [click here.](https://www.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf) * What We'll Provide:* More than just pay, our DaVita Rewards package connects teammates to what matters most including: * *Comprehensive benefits:* Medical, dental, vision, 401(k) match, paid time off, PTO cash out * *Support for you and your family:* family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave and more * *Paid training:* DaVita offers all new dialysis teammates a robust, paid training program to help you learn the right dialysis skills. The training is a mix of classroom and hands on training. * *Opportunity for a nursing career for a lifetime*. DaVita is committed to providing robust development and experiences for nurses. Whether you chose to remain in a patient facing/caregiving role or grow (leadership operations, corporate functions, integrated care, clinical research), we can guide you on that journey. We offer programs such as: * THRIVE: Develops high-potential nurses, clinical coordinators and clinic nurse managers into operational managers * DSSL & SPARK - Gives clinical teammates the chance to develop their supervisory and leadership skill set * 100+ CEU courses at no cost * Gateway: A web-based application available to teammates for career planning, learning and training, and recognition. It allows you to access new courses and CE credits and explore career paths on your own time. It also has a newsfeed to keep you up to date on Village news and functions as a social platform to connect you to teammates At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed Diversity & Belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and an affirmative action employer. As such, individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic. * Salary/ Wage Range* Compensation for the role will depend on a number of factors, including a candidate's qualifications, skills, competencies and experience and may fall outside of the range shown. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at [https://careers.davita.com/benefits](https://careers.davita.com/benefits) Davita Birmingham AL

RN - Telephonic Utilization Management Nurse - Acute Care - Remote Tn/Al Or Compact License

Humana Inc.