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

Humana Healthy Horizons in Indiana is seeking a Manager, Utilization Management (UM) Nursing who utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Manager, UM Nursing works within specific guidelines and procedures, applies advanced technical knowledge to solve moderately complex problems, and receives assignments in the form of objectives to determine approach, resources, schedules, and goals.

The Manager, UM Nursing 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.

Key responsibilities include but are not limited to:

• Operational responsibility for UM functions.
• People management responsibility of direct reports.
• Act as point of contact to coordinate pilots, changes, and initiatives across UM functions.
• Manage escalations from providers/members and internal partners.
• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Review metrics across UM spectrum and manage any unfavorable trends.
• Represent the region externally (UM) to Acute/Post-Acute and other healthcare systems.
• Delegation oversight along with other duties as assigned.

Use your skills to make an impact
 

Required Qualifications

• 3+ years of experience in utilization management.
• 2+ years of experience managing people and teams.
• Licensed Registered Nurse (RN) in the State of Indiana with no disciplinary action.
• 2+ years of experience working in a managed care or acute hospital setting.
• Ability to travel up to 10% in the state of Indiana.
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook

Work at Home Requirements

• 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.
• 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

• Preferred residence in the State of Indiana.
• BSN or bachelor’s degree in nursing.
• Process improvement or project management experience.
• Experience working with LTSS authorizations.
• Background working with Medicare and Medicaid members.
• Passionate about contributing to an organization focused on continuously improving consumer experiences.

Additional Information:

• Workstyle: Remote but may vary due to occasional onsite work at the Humana Healthy Horizons office in Indiana.
• Travel: Up to 10% travel in the state of Indiana to Humana locations.
• Core Workdays & Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• 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 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 minute