Humana
Job Title
Utilization Management Registered Nurse
Base Pay Range $71,100.00/yr – $97,800.00/yr
Workstyle Remote work at home. Must reside in a state that participates in the enhanced nurse licensure (eNLC).
Schedule Monday through Friday, 8:00 AM to 5:00 PM (most time zones). Ability to work overtime, weekends as needed.
Responsibilities
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 linkages to related areas.
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction.
Conducts medical necessity reviews for Medicaid claims and provider disputes.
Uses clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures.
Works independently under general instructions and with a team.
Required Qualifications
Active unrestricted Compact Registered Nurse (RN) license (eNLC) with no disciplinary action in the state you reside. Ability to obtain multiple state RN licenses.
At least three (3) years of clinical nursing experience, ideally in acute care, skilled nursing, or rehabilitation settings (medical-surgical, cardiology, pulmonology, maternity/obstetrics, or critical care).
Intermediate to advanced knowledge of Microsoft Word, Outlook, Excel, systems, and platforms.
Preferred Qualifications
Bachelor's degree.
Previous experience in prior authorization, claims, provider disputes, or utilization management in healthcare, evaluating medical necessity and appropriateness of care.
Health Plan/MCO experience.
Previous Medicare/Medicaid experience.
Training Training program spans approximately four weeks, with sessions scheduled from 8:00 AM to 5:00 PM Eastern Time. Additional virtual training opportunities will be provided.
Travel Less than 5% of duties may require travel; occasional travel to Humana offices for training or meetings may be required.
Benefits Humana offers competitive benefits including medical, dental, vision, 401(k), paid time off, short- and long-term disability, life insurance, and more.
Equal Opportunity Employer Humana is an Equal Opportunity Employer and prohibits discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status.
SSN Alert Applicants may be asked to provide SSN. Instructions will be sent via email.
Interview Format Interview conducted via HireVue video technology.
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Health Care Provider; Industries: Insurance
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Base Pay Range $71,100.00/yr – $97,800.00/yr
Workstyle Remote work at home. Must reside in a state that participates in the enhanced nurse licensure (eNLC).
Schedule Monday through Friday, 8:00 AM to 5:00 PM (most time zones). Ability to work overtime, weekends as needed.
Responsibilities
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 linkages to related areas.
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction.
Conducts medical necessity reviews for Medicaid claims and provider disputes.
Uses clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures.
Works independently under general instructions and with a team.
Required Qualifications
Active unrestricted Compact Registered Nurse (RN) license (eNLC) with no disciplinary action in the state you reside. Ability to obtain multiple state RN licenses.
At least three (3) years of clinical nursing experience, ideally in acute care, skilled nursing, or rehabilitation settings (medical-surgical, cardiology, pulmonology, maternity/obstetrics, or critical care).
Intermediate to advanced knowledge of Microsoft Word, Outlook, Excel, systems, and platforms.
Preferred Qualifications
Bachelor's degree.
Previous experience in prior authorization, claims, provider disputes, or utilization management in healthcare, evaluating medical necessity and appropriateness of care.
Health Plan/MCO experience.
Previous Medicare/Medicaid experience.
Training Training program spans approximately four weeks, with sessions scheduled from 8:00 AM to 5:00 PM Eastern Time. Additional virtual training opportunities will be provided.
Travel Less than 5% of duties may require travel; occasional travel to Humana offices for training or meetings may be required.
Benefits Humana offers competitive benefits including medical, dental, vision, 401(k), paid time off, short- and long-term disability, life insurance, and more.
Equal Opportunity Employer Humana is an Equal Opportunity Employer and prohibits discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status.
SSN Alert Applicants may be asked to provide SSN. Instructions will be sent via email.
Interview Format Interview conducted via HireVue video technology.
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Health Care Provider; Industries: Insurance
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