Humana

SNF UM RN Nurse

Posted on

April 4, 2025

Job Type

Full-Time

Role Type

Triage

License

RN

State License

Compact / Multi-State

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Company Description

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.

Job Description

The SNF 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.

Requirements

Required Qualifications: Bachelor's degree Compact License required Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action. 2-3 years Skilled nursing facility experience and /or skilled nursing facility utilization management review experience. 3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience required Previous experience in utilization management required Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting 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 Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications: 3 or more years experience in a high volume community or mail order pharmacy practice environment 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

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Responsibilities

The SNF 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.

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