SNF Utilization Management RN - Compact Rqd

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. The role uses clinical knowledge, communication skills, and independent critical thinking to interpret 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 guidance where needed. Follows established guidelines/procedures.

• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
• Interpret criteria, policies, and procedures to determine appropriate care or services for members.
• Make decisions regarding own work methods, occasionally in ambiguous situations, with minimal direction and guidance as needed.
• adhere to established guidelines and procedures.

• Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action.
• MUST have Compact License
• Greater than one year of clinical experience in an RN role in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc.
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Ability to work independently under general instructions and with a team
• Must be passionate about 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 with preference for specialty areas such as critical care, emergency room, trauma units, etc.
• Experience as an MDS Coordinator or discharge planner in an acute care setting
• Previous experience in utilization management/utilization review for a health plan or acute care setting
• Compact license PLUS a single state RN Licensure in any of the following non-compact states:
  California, Hawaii, Nevada, Oregon
• Health Plan experience
• Previous Medicare/Medicaid Experience a plus
• Call center or triage experience
• Bilingual is a plus

• Scheduled Weekly
  
  Hours:
  
  40
• Travel:
  While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

• 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 of 25 Mbps download x 10 Mbps upload is required for optimal performance.
• Check your internet speed at
• A dedicated office space lacking ongoing interruptions to meet productivity requirements and to protect member PHI / HIPAA information.

Salary: $71,100 - $97,800 per year. The compensation range reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. Pay may be higher or lower based on geographic location and demonstrated job-related skills, knowledge, experience, education, certifications, etc.

Description of Benefits:
Humana offers competitive benefits that support whole-person well-being, including medical, dental and vision benefits, 401(k), paid time off, holidays, voluntary time off, paid parental and caregiver leave, disability coverage, life insurance, and other opportunities.

About One Home:
One Home coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. One Home’s patient-focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health…