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

The Utilization Management (UM) Nurse 2 RN utilizes clinical nursing skills to support the coordination, documentation and communication of long-term supports and services and/or benefit administration determinations. The UM Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The UM Nurse 2 work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors

Position Responsibilities

• Uses clinical knowledge, communication skills, and independent critical thinking skills towards.

• Interpreting criteria, policies, and procedures related to Long Term Services and Support authorizations 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.

• Understands department and organizational strategy and operating objectives, including their linkages to related areas.

• Follows established guidelines/procedures.

• Makes decisions regarding own work methods, occasionally in ambiguous situations, requires minimal direction and receives guidance where needed.

Use your skills to make an impact
 

Required Qualifications

• Active Registered Nurse license in the state of Virginia, or obtain a multi-state license a bordering contiguous state that participates in the enhanced licensure, (eNLC) without disciplinary action

• 1+ year previous experience in utilization management

• 2+ years prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting

• Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment

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

Preferred Qualifications

• LTSS service authorization, waiver experience

• Previous Medicare/Medicaid experience

• Previous experience in discharge planning and/or home health or rehabilitation

• Bilingual preferred (Spanish, Arabic, Vietnamese or other)

Additional Information:

Workstyle: Remote work at Home

Location: Virginia or reside within 40 miles of one of the following contiguous bordering states - Tennessee, West Virginia, North Carolina, Maryland, or Kentucky

Schedule: Must work a minimum of 8 hours between 8:00AM to 5:00 PM Eastern Time, may be required to work rotating holidays or weekends as determined by business needs

Travel: Less than 25% to attend onsite market meetings as business needs

Work-at-Home (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.

Language Assessment Statement

Any Humana employee who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

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