Become a part of our caring community and help us put health first
 

The RN, Utilization Management (UM) Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of long-term services and supports (LTSS) and/or benefit administration determinations. The UM Nurse’s work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The UM Nurse 2 work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Uses clinical knowledge, communication skills, and independent critical thinking skills towards:

• Interpreting criteria, policies, and procedures related to Long Term Services and Support authorizations to provide the best and most appropriate treatment, care, or services for members.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
• Understand department and organizational strategy and operating objectives, including their linkages to related areas.
• Follow established guidelines/procedures.
• Make decisions regarding own work methods, occasionally in ambiguous situations, requires minimal direction and receives guidance where needed.

Use your skills to make an impact
 

Required Qualifications

• Must reside in the state of Michigan, Ohio, Illinois or Indiana.  

• An Active, unrestricted Registered Nurse (RN) license in the state of Michigan.
• One (1) year of previous experience in utilization management/LTSS service authorization.
• Two (2) years prior clinical experience, preferably in acute care, skilled or rehabilitation clinical setting, or Medicaid Managed Care Organization.

• Must be able to work Eastern Standard Time, Monday – Friday; 8:00am – 5:00pm in Eastern Standard Time (EST).

• Comprehensive knowledge of Microsoft Word, Outlook and Excel.
• Ability to work independently under general instructions and with a team.

Preferred Qualifications

• Bachelor’s or associate degree in nursing or other related field.
• Previous Medicare/Medicaid experience.
• Previous experience in discharge planning and/or home health or rehabilitation.
• Bilingual preferred Spanish, Arabic, Chaldean Neo-Aramaic or other.

Additional Information

• Workstyle: This is a remote position.

• Travel: Occasional travel may be required to attend onsite team engagement meetings at Humana’s Detroit, Michigan office.

• Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

WAH INTERNET STATEMENT:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Must work from a dedicated space that is lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$71,100 - $97,800 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.