Utilization Management Nurse

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

📋 Description

• Assist in the coordination, documentation, and communication of medical services and benefit administration decisions.

• Analyze clinical criteria, policies, and procedures to identify suitable treatment, care, or services.

• Utilize clinical expertise and independent critical thinking to ensure optimal care for members.

• Collaborate and communicate effectively with providers, members, and other stakeholders.

• Make autonomous decisions regarding work methodologies while adhering to established guidelines and protocols.

• Occasionally travel to Humana offices for training sessions or meetings.

⛳️ Requirements

• A Bachelor's degree is required.

• Must be a Licensed Registered Nurse (RN) in the state of Ohio with no disciplinary actions.

• Minimum of 3 years experience in Medical Surgery, Heart, Lung, or Critical Care Nursing.

• Prior experience in utilization management is necessary.

• Clinical experience is preferred, particularly in an acute care, skilled nursing, or rehabilitation setting.

• A strong desire to contribute to an organization that is dedicated to enhancing consumer experiences.

• Preferred: At least 3 years of experience in a high-volume community or mail-order pharmacy practice.

• Preferred: Experience in a Health Plan environment.

• Preferred: Prior experience with Medicare/Medicaid.

• Preferred: Experience in a call center or triage setting.

• Preferred: Bilingual candidates are encouraged to apply.

• TB screening must be completed if selected.

• A minimum home internet speed of 25 Mbps download and 10 Mbps upload is required.

• Ability to work from a designated space free of interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan.

• 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.

• Dedicated home workspace arrangement.

• Remote work arrangement.

• Internet service requirements/support for home employees.