Humana RN Telephonic Acute Utilization Management – Eastern time zone in Lancaster, South Carolina

Role:RN Telephonic Acute Utilization Management

Assignment:Medicare

Location:Work at Home anywhere in Eastern time zone

The hours of this role are Mon-Fri, 8am-5pm est.

Assignment Capsule

Humana is seeking a Utilization Management RN who will review clinical information to ensure appropriateness of services, utilizing Milliman and CMS guidelines.Interact with providers utilizing effective collaboration to insure safe discharge.Collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.

  • Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design

  • Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally

  • Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols

  • Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria

  • Conduct admission review, post-discharge calls and discharge planning

Role Essentials

  • Active RN license in the state(s) in which the nurse is required to practice

  • Ability to be licensed in multiple states without restrictions

  • Previous experience in utilization management, case management, discharge planning and/or home health or rehab strongly preferred.

  • At least 3 years clinical experience in an adult acute care setting

  • Strong computer and communication skills

  • Experience meeting or exceeding metrics in a dynamin environment
  • Ability to work independently under general instructions and with a team

  • Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10Mx1M

Role Desirables

  • Interqual or Milliman

  • Medicare experience

  • Managed care experience

  • Call center or triage experience

Additional Information

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice 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.

If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Title: RN Telephonic Acute Utilization Management – Eastern time zone

Location: GA-Atlanta

Other Locations: US-North Carolina-Charlotte, US-Virginia-Glen Allen, US-FL-Tampa, US-South Carolina-Lancaster

Requisition ID: 178535