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

Humana Healthy Horizons in Oklahoma is seeking a Manager, Utilization Management (UM) Physical Health Nurse, who utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.

The Manager, UM Physical Health Nurse, works within specific guidelines and procedures, applies advanced technical knowledge to solve moderately complex problems, and receives assignments in the form of objectives and determines approach, resources, schedules and goals.

The Manager, UM Physical Health 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.

The Manager roles and responsibilities include but not limited to:

• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Makes decisions related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
• Requires cross departmental collaboration and conducts briefings and area meetings.
• Maintains frequent contact with other managers across the department.

Use your skills to make an impact
 

Required Qualifications

• Must reside in the State of Oklahoma.
• 2+ years of leadership/management experience.
• Licensed Registered Nurse (RN) in the State of Oklahoma (or compact license) with no disciplinary action.
• Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
• 2+ years of utilization management experience.
• Experience leading UM trend initiatives.
• Experience working collaboratively across multiple functional areas and fostering teamwork.
• Excellent communication skills (written, oral, and presentation skills).
• Ability to use data and analytical thinking to make fact-based decisions and/or recommendations.
• Advanced proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint.

Preferred Qualifications

• Bachelor's Degree.
• Health Plan experience.
• Prior Medicare / Medicaid experience.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
• Associates 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 associates 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

Additional Information

• Direct Reports: 10-14 associates
• Workstyle: Remote, work from home in the State of Oklahoma.
• Travel: Quarterly in-person meeting in Oklahoma City.
• Core Workdays & Hours: Typically, Monday – Friday 8:00am – 5:00pm Central Standard Time (CST).
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of quest