Utilization Management Nurse - Home Solutions - Compact RN Required

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

Full-Time, Remote Telephonic opportunity

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.

As a Utilization Management RN working on the OneHome / Home Solutions UM Team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal at home.

In this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.

Role

The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Success in this role requires the following :

Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Excellent organizational and time management skills

Solid analytical skills to understand and interpret clinical information to make recommendations to improve patient outcomes.

Technical savvy and ability to navigate multiple systems and screens while working cases.

Collaboration skills to effectively interact with multiple parties both internal and external.

An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed.

Ability to follow established guidelines, processes, and procedures.

Use Your Skills To Make An Impact

Shift is Monday - Friday 8 : 00am - 5 : 00pm Eastern Standard Time

Required Qualifications

Minimum of Associate Degree in nursing

Licensed Registered Nurse (RN) in a compact state with no disciplinary action.

Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.

Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population

Effective telephonic and virtual communication skills

Comprehensive knowledge of Microsoft Word, Outlook and Excel

Ability to work independently under general instructions and within a team.

Preferred Qualifications

Bachelor’s degree

Two (2) or more years of home health experience and / or utilization management experience

Experience in a managed care setting

Health Plan experience

CGX experience

Work-At-Home Requirements

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).

A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.

Check your internet speed at www.speedtest.net

A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information

Travel : While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Travel : While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and / or individual performance.

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About OneHome : OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.

About Humana : Humana Inc. (NYSE : HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.