FL – Telecommute
RN – Utilization Management, WAH FL – 8AM-5PM Monday-Friday w/weekend rotations
Work at Home Florida
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.
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.
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.
Licensed Registered Nurse (RN) in the state of Florida without restriction and ability to be licensed in multiple stated without restrictions
Must be willing to work Monday-Friday from 8:00AM-5:00PM within local time zone. In addition there will be rotating weekend and holidays. This will be discussed with the manager if selected for interview
3-5 years of Medical Surgical, Heart, Lung or Critical Care Nursing experience required
Prior clinical experience preferably in an acute care, clinical setting
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and with a team
Additional Requirements based on location:
Monday through Friday 8:00 AM – 5:00 PM Eastern Time with weekend rotations
Work style: This position is considered work at home. Potential Onsite facility visits within a 60 mile radius may be required for coverage or as business needs change
Must have a separate room for privacy with a locked door during working hours and during communication with members
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 50×1 (50mbs download x 1mbs upload) is required
Travel: The following will be need to be completed in the event this position requires onsite facility visits
As part of part of Humana/Senior Bridge’s Tuberculosis (TB) screening program, you will be required to be screened for TB if you are selected for the role
Possession of a valid driver’s license and access to a reliable automobile
This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
AHCA Fingerprint Required.
Education: BSN or Bachelor’s degree in a related field
Previous experience in utilization management required
Knowledge of MCG
Health Plan experience
Previous Medicaid Experience a plus
Call center or triage experience
Bilingual is a plus
Scheduled Weekly Hours: 40
Bilingual , Call Center , Insurance , Medical & Health , Case Management , Nursing