RN - Utilization Review -WAH Telephonic - Medicare - SE Regi

at Humana in Rogers, Arkansas, United States

Job Description


The Utilization Management Nurse 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.


The hours of this role are Mon-Fri, 8am-5pm EST

Creating Healthy Communities is good for the Soul. Join Us! The 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

+ Coordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning including to assist with social determinants and closing gaps

+ 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

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications

+ Active RN license without restrictions in GA or SC or compact state / multi state license

+ Ability to be licensed in multiple states without restrictions

+ Prior clinical experience preferably in an acute care environment

+ Excellent computer skills and ability to easily navigate multiple applications

+ Ability to work independently under general instructions and with a team

+ 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 10×1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

+ Prior Utilization review experience

+ Health Plan experience

+ Previous Medicare/Medicaid Experience a plus

Additional Information

As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.

If you are selected for a phone screen you will receive an email inviting you to participate in a Montage /Text Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.

Scheduled Weekly Hours


Copy Link

Job Posting: JC213925509

Posted On: May 19, 2022

Updated On: May 26, 2022