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Utilization Management RN - Physical Health

Humana

Humana

Oklahoma, USA · Remote
Posted on Tuesday, December 12, 2023

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

Why Humana?

At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we’ve got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future.

Fostering a culture of inclusion is part of the fabric of who we are. We must have a workplace that reflects the people we serve and thrives in part because every person can bring their whole self to work to do their best work. Our vibrant, diverse culture and environment of inclusion is one of our greatest strengths.

About Humana Healthy Horizons

Humana Healthy Horizons is more than a health plan. We’re human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health.

The Utilization Management (UM) Nurse 2 uses clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. The Utilization Management Nurse 2's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Position Responsibilities:

  • Uses clinical knowledge, communication skills, and independent critical thinking skills toward interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for Enrollees
  • Coordinates and communicates with Providers, Enrollees 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 situation, requiring minimal direction and receiving guidance where needed
  • Follows established guidelines and procedures
  • Periodic travel to Humana Oklahoma City office for meetings and training


Use your skills to make an impact

Required Qualifications:

  • Must Reside in Oklahoma
  • An active Licensed Registered Nurse (RN), a licensed Master’s Level Social Worker (LCSW, LMSW, LMSW-ACP, CSW, LPC, LMFT) or a Psychologist (PhD/EdD) in the State of Oklahoma without restrictions.
  • 3+ years of medical surgery, heart, lung, or critical nursing experience
  • Previous experience in Utilization Management
  • Prior clinical experience, preferably in an acute care, skilled or rehabilitation clinical setting
  • Ability to work independently under general instructions and with a team

Our Benefits

Health benefits effective day 1. Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

  • Paid time off, holidays, volunteer time and jury duty pay, Recognition pay.
  • 401(k) retirement savings plan with employer match.
  • Tuition assistance, Scholarships for eligible dependents.
  • Parental and caregiver leave.
  • Employee charity matching program.
  • Network Resource Groups (NRGs).
  • Career development opportunities.

Travel

Must have a Valid driver’s license with reliable transportation and the ability to travel within the state, as required

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.

Work at Home Criteria

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 recommended; wireless, wired cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if approved by leadership.
  • Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$69,800 - 87,000

Scheduled Weekly Hours

40


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.


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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.