Utilization Management, Licensed Practical Nurse, LPN Registered Nurse, RN

Responsibilities

The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

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  Active Licensed Practical Nurse, (LPN), or Licensed Registered Nurse (RN) in the state of Florida with no disciplinary action.
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  Minimum 3 years clinical experience in an acute care, skilled, long term care or rehabilitation setting
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  Minimum 3 years experience in utilization management
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  Comprehensive knowledge of Microsoft Word, Outlook and Excel
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  Ability to work independently under general instructions and with a team

Addtional Requirements/Adherence

Workstyle: Remote Work at Home

Location: Florida

Alternate Location: May be considered

Hours: Monday through Friday 8:30 AM-5:00 PM

Travel: No more than 5% travel based on business needs

Remote Work at Home Requirements

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  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 of 25x10 (25mbs download x 10mbs upload) is required

Preferred Qualifications

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  Education: BSN or Bachelor's degree in a related field
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  3-5 years of Long Term Services and Supports (LTSS) experience
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  Previous Medicare/Medicaid experience
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  3 or more years experience in a high volume community or mail order pharmacy practice environment
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  Health Plan experience
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  Previous Medicare/Medicaid Experience a plus
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  Call center or triage experience
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  Bilingual is a plus

Additional Information:

Covid Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours