Humana Onsite Acute Utilization Management Nurse – Baptist Health Louisville in Louisville, Kentucky
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.
Active RN license in the state(s) in which the nurse is required to practice
Prior clinical experience in an acute care setting
Ability to work independently under general instructions and with a team
Ability to research and problem solve independently
Strong listening and communication skills
Positive attitude and ability to adapt to change quickly
Proficient with Microsoft Office including Word, Excel and Outlook and Excel
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Valid driver’s license and/or dependable transportation necessary (variable by region)
This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
Education: BSN or Bachelor’s degree in a related field
Previous Medicare Experience
Health Plan experience
Previous experience in utilization review
Work location: This role requires being onsite daily
Hours are: Monday-Friday 8:00am-5:00pm
Scheduled Weekly Hours
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
Equal Opportunity Employer
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