Sr Utilization Management Professional - RN

Profile

Description

The Senior Utilization Manager RN provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE product implementation, operations, contract compliance, and federal contract application submissions. The work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Utilization Manager RN serves as the primary resource on regulations for all assigned health plans. Ensures that assigned health plans are meeting or exceeding corporate Medicare/Medicaid/TRICARE performance benchmarks. Maintains relationships with regulators within a region. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

Registered Nurse

Utilization Management Experience

5 or more years of experience in a fast paced insurance or health care setting

Excellent communication skills, both oral and written

Experience implementing and measuring success on complex health-related initiatives and pilots

Strategic thinker with ability to work independently

Strong relationship building skills

Strong analytical skills

Process-focused, with ability to leverage and enhance existing processes

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Master's Degree

Healthcare experience

Our Hiring Process

We may contact you via text message and email to gather more information once we review your application. We use a software platform called Modern Hire. Modern hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com