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UM Nurse, Remote FL
R-387421
Description
Become a part of our caring community and help us put health first
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. The 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 in Humana’s Florida LTSS program.
- 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.
Use your skills to make an impact
Required Qualifications- Active Licensed Practical Nurse, (LPN) or Licensed Registered Nurse (RN) in the state of Florida with no disciplinary action.
- Minimum of one (1) year of LTSS (Long Term Supports and Services) experience.
- Previous experience in utilization management.
- Comprehensive knowledge of Microsoft Word, Outlook and Excel.
- Bachelor's degree.
- Previous Medicare/Medicaid experience.
- Previous case management experience.
- Previous CGX experience.
- MCG certification.
- Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
- Work Location: must reside in Florida.
- Travel: no more than 5% based on business needs.
- Typical Work Days/Hours: Monday – Friday, 8:30 am – 5:00 pm EST.
- 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.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees 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.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
