Onsite Utilization Management Field Nursing Professional 2 (Phoenix, AZ)
- Flexible / Remote
The Utilization Management Field Nursing Professional 2 utilizes clinical nursing skills in the field to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Field Nursing Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Utilization Management Field Nursing Professional 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, andrequires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
- Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
- 3-5 years of prior clinical experience preferably in an acute care hospital, skilled or rehabilitation clinical setting
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- Ability to work independently under general instructions and with a team
- Ability to thrive in a changing work environment
- Excellent communication skills both verbal and written
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- This role is considered patient facing and is part of Humana/Senior Bridge's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
- 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
- Education: BSN or Bachelor's degree in a related field
- Previous experience in utilization management
- Milliman MCG guidelines experience
- Health Plan experience
- Previous Medicare/Medicaid experience a plus
- Bilingual is a plus
- Hours for this role are: Monday-Friday 8am-5pm PST this includes a weekend rotation
- This role is located onsite for part of the day at a local hospital in Phoenix, AZ and the remainder of the day will be work at home
- Candidates must live within close proximity to major hospitals in the Phoenix, AZ area
- The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective April 1, 2011, Humana has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.
Scheduled Weekly Hours
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