Utilization Management Nurse

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations • work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action • makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed • coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment

🎯 Requirements

• Licensed Registered Nurse (RN) with at least 3 years prior clinical experience in an acute care, skilled, long term care or rehabilitation setting • Licensed Practical Nurse (LPN) with at least 5 years of clinical experience in acute care, skilled, long term care or rehabilitation setting. • MUST reside in the state of FLORIDA • License in the state of Florida with no disciplinary action • BSN or Bachelors degree in a related field (preferred) • Prior experience in utilization management/review and or prior authorizations (preferred) • Background in case management for Long-Term Services and Supports (LTSS) members (preferred) • Experience with MCG guidelines (preferred) • Experience evaluating requests for durable medical equipment (preferred) • Familiarity with health plan operations (preferred)

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance