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

Utilization Management Nurse - Front End Review 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.

How we Value You
Medical, Dental, Vision benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being

               

The Utilization Management Nurse - Front End Review 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, utilize MCG criteria to perform acute concurrent front-end reviews on Humana members to determine medical necessity.

Must be willing to comply with the following:

• Thursday through Sunday between 7:00 AM to 6:00 PM Eastern

• Must be willing to work 2 holidays annually

Use your skills to make an impact
 

Required Qualifications:

• Licensed Registered Nurse (RN) in Florida with no disciplinary action.

• 3 or more years of clinical experience preferably in an acute care- inpatient hospital setting.

• Intermediate or better working using Microsoft Word, Outlook and Excel

• Ability to work independently under general instructions and with a team

• Strong general computer skills in an autonomous work setting.

Additional Requirements/Adherence

Workstyle: Remote Work at Home

Location: Supporting Florida Market

Hours:

• Thursday through Sunday between 7:00 AM to 6:00 PM Eastern

• Must be willing to work 2 holidays annually

Travel: None

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

Preferred Qualifications

• Bachelor's degree

• Front End Review experience

• Previous experience in Utilization Management 

• CGX experience

• MCG experience

• Health Plan experience

• Previous Medicare/Medicaid Experience 

Additional Information

Covid Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. 

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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 questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you wi