Utilization Management Nurse

🔥 13 hours ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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

• Utilize clinical nursing skills to support coordination, documentation, and communication of medical services and/or benefit administration determinations • Interpret criteria, policies, and procedures to provide appropriate treatment, care, or services for members • Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment • Support the Medicaid Care Management team • Make decisions regarding work methods, including in ambiguous situations, with minimal direction • Follow established guidelines and procedures • Work Monday through Friday, 8:00 AM to 5:00 PM Central Time • Participate in overtime and weekend rotations as needed • Complete approximately four to six weeks of training from 8:00 AM to 5:00 PM • Travel occasionally to Humana offices for training or meetings

🎯 Requirements

• Licensed Registered Nurse (RN) in the state of Louisiana with no disciplinary action • Ability to be licensed in multiple states • 3+ years of varied RN nursing experience • Comprehensive knowledge of Microsoft Word, Outlook and Excel • Ability to work independently under general instructions and with a team • Must reside and conduct work in the state of Louisiana • Must be able to work a 40-hour work week, Monday through Friday, 8:00 AM to 5:00 PM Central Time • Overtime and weekend rotation may be requested • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information • Home internet with at least 25 Mbps download and 10 Mbps upload speed • Wireless, wired cable, or DSL internet connection required • Satellite, cellular, or microwave connection requires leadership approval • BSN or Bachelor's degree in a related field preferred • Experience in Utilization Management Review and/or Prior Authorization preferred • Health Plan experience preferred • Previous Medicare/Medicaid experience a plus • Experience with MCG guidelines preferred • Compact Nursing License preferred • Must not be a current or former Louisiana Health Department agency head, elected official, board or commission member, or public employee working directly with LDH's Medicaid Division unless separated from LDH for two or more years

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Wellness and smart healthcare decision support • Remote work at home • Humana-provided telephone equipment • Occasional virtual training opportunities