Humana
Humana Inc. (NYSE: HUM) is committed to putting health first ā 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 ā 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.
Humana Healthy Horizons is seeking a Utilization Management Nurse who utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 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.
Active unrestricted Licensed Registered Nurse (RN) in the state of South Carolina or Compact State License with no active disciplinary action. Minimum two, (2) years of clinical acute care, skilled nursing, rehab or transitional care experience. Prior experience in utilization management. Intermediate to advanced proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint. Excellent communication skills (written and verbal). Ability to work independently under general instructions and with a team. Preferred Qualifications: Bachelor's degree. Health Plan experience. Behavioral Health experience. Prior Medicare / Medicaid experience. Additional Information Workstyle: Remote, work at home Location: Must reside in South Carolina Travel: Occasional travel, up to 1 time per quarter. Schedule: Typically, Monday through Friday 8:00am ā 5:00pm Eastern Standard Time (EST). Work at Home Guidance: To ensure Home or Hybrid Home/Office associatesā ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must have a 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 with 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
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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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