Utilization Management RN - Physical Health

The Utilization Management (UM) Nurse uses clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. The Utilization Management Nurse 2's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Position Responsibilities

• Use clinical knowledge toward interpreting criteria and procedures to provide the best and most appropriate treatment, care, or services for Enrollees
• Coordinate and Communicate with Providers, Enrollees or other parties to facilitate optimal care and treatment
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas
• Use judgment regarding own work methods, occasionally in ambiguous situation, and receiving guidance where needed
• Follow established guidelines and procedures
• Periodic travel to Humana Oklahoma City office for meetings and training

Required Qualifications

• Must Reside in Oklahoma
• An active Licensed Registered Nurse (RN), unrestricted
• 3+ years of prior clinical experience, preferably in an acute care, skilled or rehabilitation clinical setting
• Comprehensive knowledge of Microsoft Excel and Outlook
• Ability to work a weekend rotation

Preferred Qualifications

• Previous experience in Utilization Management
• Prior experience with EPIC Programs
• Previous remote work experience

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions 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.

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.