Utilization Management Nurse 2

Must reside in Michigan or within 40 miles of the border in Indiana or Ohio. Active Registered Nurse (RN) in the state of Michigan with no disciplinary action. 1-year previous experience in utilization management/LTSS service authorization. At least 2 years prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting, or Medicaid Managed Care Organization. Comprehensive knowledge of Microsoft Word, Outlook and Excel. 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. PREFERRED QUALIFICATIONS: Bachelor’s or Associate’s Degree in Nursing or other related field. Previous Medicare/Medicaid experience. NCQA, CM experience. Previous experience in discharge planning and/or home health or rehabilitation. Bilingual preferred (Spanish, Arabic, Chaldean Neo-Aramaic or other). ADDITIONAL INFORMATION: Workstyle: This is a remote position. Travel: May need to attend onsite meetings Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST). Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. WAH INTERNET STATEMENT: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. 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.

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