Telephonic UM Nurse - Post Acute (Rn) - Mountain Time Applicants Preferred

Humana Inc. Fort Walton Beach , FL 32549

Posted 2 weeks ago

Description

The Telephonic Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Telephonic Utilization Management Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Telephonic Utilization Management Nurse 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.

Ideal Skillset

The ideal candidate for this position will live in the Mountain Time zone; have a background working in home health; an active and unrestricted RN license; prior utilization management experience following MCG/Milliman or Interqual guidelines; prior work at home experience preferred; and strong computer skills using MS Office products and also electronic medical records.

Required Qualifications

  • Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action.

  • Previous experience with home healthcare, IRF or LTACH

  • At least 3 years of varied clinical nursing experience

  • Proficient with Microsoft Office products including Word, Excel and Outlook

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

  • 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

  • Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.

  • Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10 panel drug test

Preferred Qualifications

  • Bachelor's degree

  • Previous experience in utilization management

  • Familiarity with CMS criteria

  • Telephonic care coordination experience

  • Prior use of MCG/Milliman or Interqual guidelines

  • Health Plan experience

  • Previous Medicare/Medicaid Experience a plus

  • Prior case management experience

  • Bilingual is a plus

Additional Information

The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective April 1, 2011, Humana has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.

Scheduled Weekly Hours
40


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Telephonic UM Nurse - Post Acute (Rn) - Mountain Time Applicants Preferred

Humana Inc.