Onsite Utilization Management Nurse 2 RN - Orlando FL

Profile

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.

Responsibilities

The Onsite 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.
Must be willing to Travel 50-75% of the time to local Acute Care Facilities in Orlando, FL


Required Qualifications


Unrestricted Registered Nurse (RN) in the state of Florida without restriction and ability to be licensed in multiple states without restrictions
3-5 years acute care, (Medical Surgical, Heart, Lung or Critical Care), skilled or rehabilitation nursing experience
Previous hospital or health plan utilization management
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and with a team


Hours:


Monday through Friday 8:00 AM - 5:00 PM Local Time with weekend and holiday rotation. This will be discussed with the manager if selected for interview


Travel:


This position will require no more than 50-75% travel to Acute Care Facilities in Orlando, FL


Screening Requirements:


This role is considered patient-facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be tested for TB.
Associate working in the State of Florida will need Completion of a Level II; AHCA background clearance Fingerprinting.


Additional Requirements - temporary work at home


Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.


Preferred Qualifications


Education: BSN or Bachelor's degree in a related field
Knowledge of MCG
Health Plan experience
Previous Medicaid Experience a plus
Call center or triage experience
Bilingual is a plus - Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages.


Additional Information

Onsite Travel

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

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