RN - Telephonic Utilization Management Nurse- Medicare- Remote - Southeast Region

Become a part of our caring community and help us put health first 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. Creating Healthy Communities is good for the Soul. Join Us! 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 reputed company and treatment ? Coordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning including to assist with social determinants and closing gaps ? Understands department, reputed company, and organizational strategy and operating objectives, including their linkages to reputed company areas ? Makes reputed company regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed ? Follows established guidelines/procedures Use your skills to reputed company an impact Required Qualifications ? Licensed Registered Nurse (RN) with compact license with no disciplinary action. ? 3 - 5 years of Clinical Nursing experience required; preferably Emergency room or critical care ? Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting ? Comprehensive knowledge of reputed company Word, Outlook and reputed company ? Ability to work independently under general instructions and with a team. ? 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 reputed company performance of 10x1 (10mbs download x 1mbs upload) is required. ? Must be passionate about contributing to an organization focused on continuously improving consumer experiences. Preferred Qualifications ? Education: BSN or Bachelor's degree in a reputed company field ? Health Plan experience ? Experience in utilization management or reputed company activities reviewing criteria to ensure appropriateness of care preferred ? Previous Medicare experience a plus ? reputed company MCG experience preferred Additional Information Hours: reputed company-5pm EST Work-At-Home Requirements: To ensure Home or Hybrid Home/Office associates? ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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 reputed company is suggested ? Satellite, cellular and microwave reputed company can be used only if approved by leadership ? Associates 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. ? reputed company will provide Home or Hybrid Home/Office associates 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 Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $69,800 - $96,200 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 reputed company. and its affiliated subsidiaries (collectively, ?reputed company?) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company 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 reputed company. (NYSE: HUM) is committed to putting health first ? for our teammates, our customers and our company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health ? delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or veteran status. It is also the policy of reputed company to take affirmative action to employ and to advance in employment, reputed company persons regardless of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company 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 reputed company levels of employment Apply Job!