Humana
Utilization Management Nurse - Home Solutions - Compact RN Required
Humana, Nashville, Tennessee, United States
Join to apply for the Utilization Management Nurse - Home Solutions - Compact RN Required role at Humana
Base pay range $71,100.00/yr - $97,800.00/yr
Full‑Time, Remote Telephonic opportunity.
Role Overview 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 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM Team, you will use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value‑based care for members who desire to heal at home.
Responsibilities
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Excellent organizational and time management skills.
Solid analytical skills to understand and interpret clinical hermetic information to make recommendations to improve patient outcomes.
Technical savvy and ability to navigate multiple systems and screens while working cases.
Collaboration skills to effectively interact with multiple parties both internal and external.
An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction, receiving guidance where needed.
Ability to follow established guidelines, processes, and procedures.
Shift Schedule Monday - Friday 8:00am - 5:00pm Eastern Standard Time
Required Qualifications
Minimum of Associate Degree in nursing.
Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
Must have a valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population.
Effective telephonic and virtual communication skills.
Comprehensive knowledge of Microsoft Word, Outlook and Excel.
DOWNLOADABLE but ability to work independently under general instructions and within a team.
Preferred Qualifications
Bachelor’s degree.
Two (2) or more years of home health experience and/or utilization management experience.
Experience in a managed care setting.
Health Plan experience.
CGX experience.
Work‑At‑Home Requirements
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 is 25 mbps download × 10 mbps upload.
Check your internet speed at www.speedtest.net.
A dedicated office space with minimal interruptions so you can meet productivity requirements and protect member PHI / HIPAA information.
Travel While this is a remote position, occasional travel to Humana'sMeta offices for training or meetings may be required.
Scheduled Weekly Hours société 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 upon geographic location and individual pay will vary based on demonstrated job‑related skills, knowledge, experience, education, certifications, etc. This job is eligible for a bonus incentive plan based upon company and/or individual performance.
Benefits Description Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits encourage personal wellness and smart healthcare decisions for you and your family while also acknowledging that your life extends outside of work. Among our benefits, we provide medical, dental and vision benefits, a 401(k) retirement savings plan, paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave,_ZONE, 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 ourилл. 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 …
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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, layoff, recall, termination rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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Base pay range $71,100.00/yr - $97,800.00/yr
Full‑Time, Remote Telephonic opportunity.
Role Overview 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 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM Team, you will use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value‑based care for members who desire to heal at home.
Responsibilities
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Excellent organizational and time management skills.
Solid analytical skills to understand and interpret clinical hermetic information to make recommendations to improve patient outcomes.
Technical savvy and ability to navigate multiple systems and screens while working cases.
Collaboration skills to effectively interact with multiple parties both internal and external.
An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction, receiving guidance where needed.
Ability to follow established guidelines, processes, and procedures.
Shift Schedule Monday - Friday 8:00am - 5:00pm Eastern Standard Time
Required Qualifications
Minimum of Associate Degree in nursing.
Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
Must have a valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population.
Effective telephonic and virtual communication skills.
Comprehensive knowledge of Microsoft Word, Outlook and Excel.
DOWNLOADABLE but ability to work independently under general instructions and within a team.
Preferred Qualifications
Bachelor’s degree.
Two (2) or more years of home health experience and/or utilization management experience.
Experience in a managed care setting.
Health Plan experience.
CGX experience.
Work‑At‑Home Requirements
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 is 25 mbps download × 10 mbps upload.
Check your internet speed at www.speedtest.net.
A dedicated office space with minimal interruptions so you can meet productivity requirements and protect member PHI / HIPAA information.
Travel While this is a remote position, occasional travel to Humana'sMeta offices for training or meetings may be required.
Scheduled Weekly Hours société 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 upon geographic location and individual pay will vary based on demonstrated job‑related skills, knowledge, experience, education, certifications, etc. This job is eligible for a bonus incentive plan based upon company and/or individual performance.
Benefits Description Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits encourage personal wellness and smart healthcare decisions for you and your family while also acknowledging that your life extends outside of work. Among our benefits, we provide medical, dental and vision benefits, a 401(k) retirement savings plan, paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave,_ZONE, 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 ourилл. 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 …
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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, layoff, recall, termination rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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