Become a part of our caring community and help us put health first
 

Humana Healthy Horizons in Ohio is seeking a Senior Utilization Management Nurse who utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Nurse work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We’re proud of our Louisville roots and, as we’ve grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you’re working from home, from the field, from our offices, or from somewhere in between—you’ll feel welcome here. We’re a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It’s up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

Are you Caring, Curious and Committed? If so, apply today!

The Senior Utilization Management Nurse:

• 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
• Begins to influence department’s strategy.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without directio
• Exercises considerable latitude in determining objectives and approaches to assignments

Use your skills to make an impact
 

Required Qualifications

• Licensed Registered Nurse (RN) with no disciplinary action
• 3-5 years clinical experience in an acute or post acute care setting
• MCG or Interqual experience
• Managed care experience
• Experience with utilization management activities: discharge planning and patient education for adult acute care
• Excellent computer skills and ability to easily navigate multiple applications
• Strong communication and organization skills
• 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

 

Preferred Qualifications

• Bachelor's degree
• Medicaid managed care experience
• Hospital Utilization Management experience

 

Additional Information

About Humana

Your growth is what drives Humana forward. 

• When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don’t grow without you.
• This is a place where our nurses influence the C-suite.
• Where software engineers change lives.
• Where every associate can build a professional path where they learn and thrive. 
• Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security. 
• Because finding new ways to put health first—for our members and patients and our associates alike—is what we do. 

Work at Home Guidance

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your releva