Telephonic Utilization Management Nurse - Acute Care (Gulf South Region)
Company: Humana
Location: Madison
Posted on: May 18, 2024
|
|
Job 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 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
Daily Activities:
Reconciling census and updating existing cases as needed.
Reviewing clinical information on all new admissions and making
utilization determinations in accordance with Humana senior
products UM policies. Facilitating the transition of care.
Reviewing clinical information for the appropriateness as compared
to MCG; Communicating case status to the facility as needed.
Facilitating discharge planning and transition of care processes
through outreach to the member and collaboration with the member's
health care team to maximize the member's benefits and resources.
This includes case management referrals and any other specific
market initiatives.
Performing concurrent review and/or discharge planning for all
Humana Medicare/Medicaid hospitalized members
Updating UM cases as needed (e.g., diagnosis, notes, discharge
tools, discharge dates and dispositions) and in accordance with
Humana senior products policies and procedures.
Assisting/educating facility staff regarding Humana's processes for
prior authorization, etc.
Use your skills to make an impact
Required Qualifications
Licensed Registered Nurse (RN) compact licensure with no
disciplinary action
3+ years of prior acute care clinical 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 ---
Preferred Qualifications
Bachelor's degree in nursing (BSN)
Experience in utilization management is strongly preferred
Health Plan experience
Previous Medicare experience a plus
Milliman MCG experience preferred
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:
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
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
Humana will provide Home or Hybrid Home/Office associates 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
Additional Information
Hour are Monday-Friday 8:00am-5:00pm EST/CST
This is a remote position
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of
starting base pay for full time (40 hours per week) employment at
the time of posting. The pay range may be higher or lower based on
geographic location and individual pay will vary based on
demonstrated job related skills, knowledge, experience, education,
certifications, etc.$69,800 - $96,200 per yearThis job is eligible
for a bonus incentive plan. This incentive opportunity is based
upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively,
'Humana') offers competitive benefits that support whole-person
well-being. Associate benefits are designed to encourage personal
wellness and smart healthcare decisions for you and your family
while also knowing your life extends outside of work. Among our
benefits, Humana provides medical, dental and vision benefits,
401(k) retirement savings plan, time off (including paid time off,
company and personal holidays, volunteer time off, paid parental
and caregiver leave), short-term and long-term disability, life
insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for
our teammates, our customers and our company. Through our Humana
insurance services and CenterWell healthcare services, we make it
easier for the millions of people we serve to achieve their best
health - delivering the care and service they need, when they need
it. These efforts are leading to a better quality of life for
people with Medicare, Medicaid, families, individuals, military
service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee
or applicant for employment because of race, color, religion, sex,
sexual orientation, gender identity, national origin, age, marital
status, genetic information, disability or because he or she is a
protected veteran. It is also the policy of Humana to take
affirmative action to employ and to advance in employment, all
persons regardless of race, color, religion, sex, sexual
orientation, gender identity, national origin, age, marital status,
genetic information, disability or protected veteran status, and to
base all employment decisions only on valid job requirements. This
policy shall apply to all employment actions, including but not
limited to recruitment, hiring, upgrading, promotion, transfer,
demotion, layoff, recall, termination, rates of pay or other forms
of compensation and selection for training, including
apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and
does not discriminate on the basis of race, color, national origin,
age, disability, sex, sexual orientation, gender identity or
religion. We also provide free language interpreter services. See
our
https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Keywords: Humana, Madison , Telephonic Utilization Management Nurse - Acute Care (Gulf South Region), Executive , Madison, Wisconsin
Click
here to apply!
|