Utilization Management Nurse, RN - Hillsbourgh, Pinellas & Polk Counties - Florida - Manager
Company: Humana Inc
Location: Lutz
Posted on: January 24, 2023
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Job Description:
Utilization Management Nurse, RN - Hillsbourgh, Pinellas & Polk
Counties - FloridaDescription
The Utilization Management Nurse 2 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.
Responsibilities
The Utilization Management Nurse 2 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. Understands
department, segment, and organizational strategy and operating
objectives, including their linkages to related areas.
* Makes decisions regarding own work methods, occasionally in
ambiguous situations, and requires minimal direction and receives
guidance where needed.
* Follows established guidelines/procedures
Required Qualifications
* Unrestricted Registered Nurse (RN) in the state of Florida with
no disciplinary action.
* Minimum of 2 years clinical experience in hospital acute care
experience with a broad background to include ICU, CCU, ER and Med
Surg and/or a combination of skilled, rehabilitation, or long-term
care.
* Strong Proficiency with MS Office Suite to include Word, Excel,
Teams, Outlook
* Ability to work independently under general instructions and with
a team
* Hours: Monday - Friday 8 am- 5 pm EST
* Work style: This position is considered primarily remote/work at
home
* Location: Hillsbourgh, Pinellas or Polk Counties
* Travel: 15% onsite facility visits and/or to market offices for
business needs
Remote Work at Home Requirements
* Must have the ability to provide a high speed DSL or cable modem
for a home office. Associates or contractors who live and work from
home in the state of California will be provided payment for their
internet expense.
* A minimum standard speed for optimal performance of 25x10 (25mpbs
download x 10mpbs upload) is required.
* Satellite and Wireless Internet service is NOT allowed for this
role.
* A dedicated space lacking ongoing interruptions to protect member
PHI / HIPAA information
Transportation: (See Additional Information)
* Possession of a valid driver's license and access to a reliable
automobile
* This role is part of Humana's Driver Safety program and therefore
requires an individual to have a valid state driver's license and
proof of personal vehicle liability insurance with at least
100,000/300,000/100,000 limits.
Screening Requirements
* This role is considered patient facing and is a part of Humana's
Tuberculosis (TB) screening program. If selected for this role, you
will be required to be screened for TB.
* AHCA Fingerprint Required.
* 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.
Preferred Qualifications
* Utilization management
* Health Plan experience
* Previous Medicare/Medicaid Experience a plus
* Call center or triage experience
* Bilingual Spanish/English is a plus
* Interqual or Millman experience
Additional Information
In order to support the CDC recommendations on social distancing
and reduce health risks for associates, members and public health,
Humana is deploying virtual and video technologies for all hiring
activities. This position may be subject to temporary work at home
requirements for an indefinite period of time. These requirements
include access to a personal computing device with a camera, a
minimum internet connection speed of 25x10 (25mpbs download x
10mpbs upload), and a dedicated secure home workspace for interview
or work purposes. Humana continues to monitor the situation, and
will adjust service levels as the coronavirus situation evolves.
The following changes are temporary and will be evaluated
frequently with the goal of returning to normal operations as soon
as possible. Your Talent Acquisition representative will advise on
the latest recommendations to protect your health and wellbeing
during the hiring process.
#ThriveTogether #WorkAtHome
Interview Process
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 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 will
subsequently be informed if you will be moving forward to next
round of interviews.
Scheduled Weekly Hours
40
Keywords: Humana Inc, Brandon , Utilization Management Nurse, RN - Hillsbourgh, Pinellas & Polk Counties - Florida - Manager, Executive , Lutz, Florida
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