Utilization Management Review Nurse

🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – 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 the coordination, documentation and communication of medical services and/or benefit administration determinations • Interpret criteria, policies and procedures to determine appropriate treatment, care or services for members • Coordinate and communicate with providers, members and other parties to facilitate optimal care and treatment • Apply clinical knowledge and independent critical thinking to utilization management decisions • Understand department, segment and organizational strategy and operating objectives and their linkages to related areas • Make decisions regarding own work methods with minimal direction and guidance as needed • Follow established guidelines and procedures

🎯 Requirements

• Licensed Registered Nurse (RN) in the state of Ohio with no disciplinary action • At least 3 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience • Previous experience in utilization management • Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting • Passion for contributing to an organization focused on continuously improving consumer experiences • Selected candidates must complete tuberculosis (TB) screening • Minimum home internet download speed of 25 Mbps • Minimum home internet upload speed of 10 Mbps • Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Bachelor's Degree (preferred) • 3 or more years of experience in a high volume community or mail order pharmacy practice environment (preferred) • Health Plan experience (preferred) • Previous Medicare/Medicaid experience (preferred) • Call center or triage experience (preferred) • Bilingual (preferred)

🏖️ Benefits

• Bonus incentive plan based upon 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 • Personal wellness support • Smart healthcare decision support • Occasional travel to Humana offices for training or meetings