Job Description: 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. Job 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. Job Requirements: Ability to research and problem solve independently Previous Medicare Experience 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 10x1 (10mbs download x 1mbs upload) is required Ability to work independently under general instructions and with a team This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB Health Plan experience Must be passionate about contributing to an organization focused on continuously improving consumer experiences Positive attitude and ability to adapt to change quickly Proficient with Microsoft Office including Word, Excel and Outlook and Excel Strong listening and communication skills Active RN license in the state(s) in which the nurse is required to practice Education: BSN or Bachelor’s degree in a related field Prior clinical experience in an acute care setting Job Details: Company: Humana Vacancy Type: Full Time Job Location: Lexington, KY, US Application Deadline: N/A Apply Here vacancyoptions.com
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