Telephonic SNF Utilization Management Nurse - Knoxville TN (Office-Based)

Humana Inc. Knoxville , TN 37902

Posted 5 days 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

  • 2+ clinical experience preferably in case management, utilization review, acute care, skilled nursing or rehabilitation clinical setting

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

  • Comprehensive knowledge of Microsoft Word, Outlook and Excel

  • Ability to work independently under general instructions and with a team

Preferred Qualifications

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

  • Health Plan experience

  • Previous Medicare/Medicaid Experience a plus

  • Call center or triage experience

  • Bilingual is a plus

Additional Information

Candidate should live within a reasonable commuting distance to Knoxville TN

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
Telephonic Utilization Management Nurse Knoxville TN (Office Based)

Humana Inc.

Posted 2 months ago

VIEW JOBS 2/8/2019 12:00:00 AM 2019-05-09T00:00 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 state with no disciplinary action. * Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting * Comprehensive knowledge of Microsoft Word, Outlook and Excel * Ability to work independently under general instructions and with a team * This position is office based in Knoxville, TN Preferred Qualifications * Utilization Management Experience * Education: BSN or Bachelor's degree in a related field * Health Plan experience * Previous Medicare/Medicaid Experience a plus * Call center or triage experience * Bilingual is a plus Additional Information Scheduled Weekly Hours 40 Humana Inc. Knoxville TN

Telephonic SNF Utilization Management Nurse - Knoxville TN (Office-Based)

Humana Inc.