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Utilization Management Nurse 2 - VA/NC/MD

Job Description

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 Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Job Requirements

The hours for this role are Monday-Friday, 8am-5pm EST.
The 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.
Required Qualifications



  • Licensed RN with no disciplinary action

  • Prior clinical experience in an acute care, skilled or rehabilitation clinical setting

  • Excellent communication skills both verbal and written

  • Comprehensive knowledge of Microsoft Word, Outlook and Excel and ability to easily navigate multiple applications

  • 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



  • BSN 

  • Health Plan experience

  • Previous Medicare/Medicaid Experience a plus

  • Previous experience in utilization management

  • Call center or triage experience

  • Bilingual is a plus


Additional Information
As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.
If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.
Scheduled Weekly Hours
40

Job Snapshot

Location US-VA-Virginia Beach
Employment Type Full-Time Employee
Pay Type Year
Pay Rate N/A
Store Type Health Care, Insurance
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Company Overview

Humana

Throughout our 50-year history, Humana has always been one step ahead, constantly evolving with the changing world of healthcare. It is our proactive, forward-thinking approach that has allowed us to not only meet the needs of our customers, but also provide a challenging and exciting work experience for our associates.

Contact Information

US-VA-Virginia Beach

Snapshot
Humana
Company:
US-VA-Virginia Beach
Location:
Full-Time Employee
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care, Insurance
Store Type:

Job Description

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 Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Job Requirements

The hours for this role are Monday-Friday, 8am-5pm EST.
The 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.
Required Qualifications



  • Licensed RN with no disciplinary action

  • Prior clinical experience in an acute care, skilled or rehabilitation clinical setting

  • Excellent communication skills both verbal and written

  • Comprehensive knowledge of Microsoft Word, Outlook and Excel and ability to easily navigate multiple applications

  • 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



  • BSN 

  • Health Plan experience

  • Previous Medicare/Medicaid Experience a plus

  • Previous experience in utilization management

  • Call center or triage experience

  • Bilingual is a plus


Additional Information
As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.
If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.
Scheduled Weekly Hours
40

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Utilization Management Nurse 2 - VA/NC/MD Apply now