Utilization Management Registered Nurse – Home Health

This is a fully remote position, open to applicants in Alabama, +35 more locations.

📋 Description

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

• Ensure comprehensive care is provided at home for members.

• Analyze clinical data and offer recommendations to enhance patient outcomes.

• Navigate various systems and screens while managing cases.

• Collaborate and engage with both internal and external stakeholders.

• Make independent decisions regarding suitable courses of action.

• Adhere to established guidelines, processes, and protocols.

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

⛳️ Requirements

• A minimum of an Associate Degree in nursing is required.

• Must hold a valid Registered Nurse (RN) license in a compact state with no disciplinary actions.

• Required to possess a valid compact license or reside in a compact state and be eligible for compact licensure upgrade.

• At least three (3) years of diverse and progressive clinical experience, including direct patient care to the geriatric population.

• Strong telephonic and virtual communication abilities are essential.

• Proficient in Microsoft Word, Outlook, and Excel.

• Capability to work autonomously under general instructions and collaboratively within a team.

• Must have high-speed DSL or cable modem for a home office; satellite and wireless internet services are not permissible.

• Minimum internet speed of 25 Mbps for downloads and 10 Mbps for uploads is required.

• A dedicated office space that ensures a distraction-free environment to meet productivity standards and safeguard member PHI/HIPAA information.

• Availability to work Monday through Friday, from 8:00 AM to 5:00 PM Eastern Standard Time.

🏝️ Benefits

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

• Medical insurance benefits.

• Dental insurance benefits.

• Vision insurance benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company-recognized holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance coverage.