SNF Utilization Management RN - Compact Rqd

Overview

Join to apply for the SNF Utilization Management RN - Compact Rqd role at One Home
.

The Utilization Management Nurse 2 uses clinical nursing skills to support coordination, documentation and communication of medical services and/or benefit administration determinations. Work assignments are varied and frequently require interpretation and independent determination of appropriate actions. This role involves interpreting criteria, policies, and procedures to provide 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 and procedures.

• Utilize clinical nursing skills to support coordination, documentation and communication of medical services and/or benefit determinations.
• Interpret criteria, policies, and procedures to determine the appropriate course of action in member care decisions.
• Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment.
• Apply knowledge of department and organizational objectives to daily work and decision making.
• Work independently under general instructions and with a team, following established guidelines.

• Licensed Registered Nurse (RN) with a compact license; must hold a Compact License with no disciplinary action.
• Greater than one year of clinical RN experience in an acute care setting; preference for critical care, emergency, trauma, etc.
• Comprehensive knowledge of Microsoft Word, Outlook and Excel.
• Ability to work independently under general instructions and with a team.
• Passion for contributing to an organization focused on continuously improving consumer experiences.

• Education:
  
  BSN or Bachelor’s degree in a related field.
• Three or more years of clinical experience in an acute care setting; preference for critical care, emergency, trauma, etc.
• Experience as an MDS Coordinator or discharge planner in an acute care setting.
• Experience in utilization management/utilization review for a health plan or acute care setting.
• Compact license plus a single-state RN licensure in non-compact states listed (California, Hawaii, Nevada, Oregon).
• Health plan experience;
  Medicare/Medicaid experience a plus; call center or triage experience; bilingual is a plus.

• Scheduled Weekly
  
  Hours:
  
  40
• Travel:
  Remote position with occasional travel to Humana’s offices for training or meetings as required.

• Must provide a home office with high-speed internet (DSL or cable; satellite/wireless not allowed).
• Minimum speed: 25 Mbps download x 10 Mbps upload.
• Dedicated office space free of interruptions to protect member PHI/HIPAA information.

Pay Range

The compensation range is a starting base pay for full-time employment and may vary by location and individual qualifications: $71,100 - $97,800 per year
.

About One Home:
One Home coordinates post-acute care including home health, infusion therapy, and durable medical equipment at patients’ homes. Acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and caring. We offer a comprehensive benefits package to support health and financial well-being.

About Humana:
Humana Inc. is committed to putting health first for teammates, customers, and the company. We deliver care and services across Medicare, Medicaid, families, individuals, and communities.

Humana does not discriminate on any protected characteristic and complies with applicable equal opportunity and affirmative action laws.