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

The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

• Responsible for providing leadership and oversight of the physical health utilization management (UM) staff in daily operations.
• Uses clinical knowledge, communication skills, and independent critical thinking skills toward interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.
• Hire, train, coach, counsel and evaluate performance of direct reports.
• Implements and maintain processes that are compliant with the Michigan Department of Health and Human Services (MDHHS) and National Committee for Quality Assurance (NCQA) guidelines.
• Works collaboratively with UM leadership to assess and mitigate inefficiencies and provide solutions to improve clinical outcomes.
• Collect and analyze data as necessary to drive operational metrics and associate performance.
• Coordinate and communicate with Providers, Members, or other parties to facilitate optimal care and treatment.
• Makes decisions that are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
• Facilitate cross-departmental collaboration and conduct briefings and area meetings; maintain frequent contact with other managers across functional areas.

Use your skills to make an impact
 

Required Qualifications

• An active, unrestricted Registered Nurse (RN) license in the state of Michigan.
• Previous experience in utilization management and/or utilization review.
• Minimum of two (2) years of proven experience in management or leadership role.
• Prior clinical experience preferably in an acute care, skilled, or rehabilitation clinical setting.
• Ability to work independently under general instructions and with a team.

Preferred Qualifications

• BSN, bachelor’s degree in health services, healthcare administration, or business administration.

Additional Information

• Workstyle: This is a remote position.
• Travel: Up to 25% travel may be required to attend onsite team engagement meetings at Humana’s Detroit, Michigan office, as well as conferences and events both within and outside the state of Michigan.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST)
• Direct Reports: Up to 15 associates.

WAH Internet Statement

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 required; 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 HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, cert