Utilization Management Nurse

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Apply clinical nursing expertise to aid in the coordination, documentation, and communication of medical services and/or benefit administration assessments.

• Analyze criteria, policies, and procedures to deliver suitable treatment, care, or services for members.

• Collaborate and communicate with providers, members, and other stakeholders to ensure optimal care and treatment.

• Assist the Medicaid Care Management team.

• Make decisions regarding work methods, including in ambiguous situations, with minimal supervision.

• Adhere to established guidelines and procedures.

• Work Monday to Friday, from 8:00 AM to 5:00 PM Central Time.

• Participate in overtime and weekend rotations as required.

• Complete approximately four to six weeks of training from 8:00 AM to 5:00 PM.

• Occasionally travel to Humana offices for training or meetings.

⛳️ Requirements

• Active Registered Nurse (RN) license in the state of Louisiana with no disciplinary actions.

• Capability to obtain licensure in multiple states.

• Over 3 years of diverse RN nursing experience.

• Extensive knowledge of Microsoft Word, Outlook, and Excel.

• Ability to work independently under general supervision as well as collaboratively within a team.

• Must reside and perform work in the state of Louisiana.

• Must be able to commit to a 40-hour work week, Monday through Friday, from 8:00 AM to 5:00 PM Central Time.

• Overtime and weekend shifts may be requested.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information.

• Home internet service with a minimum of 25 Mbps download and 10 Mbps upload speed.

• A wireless, wired cable, or DSL internet connection is necessary.

• Satellite, cellular, or microwave connections require leadership approval.

• BSN or a Bachelor's degree in a relevant field is preferred.

• Experience in Utilization Management Review and/or Prior Authorization is preferred.

• Health Plan experience is preferred.

• Previous experience with Medicare/Medicaid is advantageous.

• Familiarity with MCG guidelines is preferred.

• A Compact Nursing License is preferred.

• Must not be a current or former head of the Louisiana Health Department agency, elected official, board or commission member, or public employee directly involved with LDH's Medicaid Division unless separated from LDH for two or more years.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Wellness and smart healthcare decision support.

• Remote work from home.

• Humana-provided telephone equipment.

• Occasional virtual training opportunities.