Humana Jobs in Appleton – Onsite Acute Utilization Management Nurse

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:

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Case Management experience is required
• Home Health experience
• Ability to work independently under general instructions and with a team
• 3-5 years of clinical experience in an acute care hospital clinical setting
• Health Plan experience
• Previous experience in utilization management
• Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
• Excellent communication skills both verbal and written
• Milliman MCG guidelines experience
• Comprehensive knowledge of Microsoft Office, Word, Outlook and Excel
• Education: BSN or Bachelor’s degree in a related field
• Previous Medicare/Medicaid experience a plus
• Positive attitude and ability to adapt to change quickly

Job Details:

Company:  Humana

Vacancy Type:  Full Time

Job Location: Appleton, WI, US

Application Deadline: N/A

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