Humana Acute Onsite RN - Utilization Review in Louisville, Kentucky

Role:Acute Onsite RN - Utilization Review

Assignment:Medicare

Location:Louisville, KY

(This role is a 100% onsite at a centralized utilization review office for Norton Healthcare System located in the Watterson Towers on Bishop Lane which is off the Watterson Expressway)

Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule

Be a part of our Clinical Space – as an Onsite Nurse you will engage our members to develop lifelong wellbeing and health.

Humana is seeking an Onsite Nurse who will 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

  • Prior clinical experience in an acute care setting

  • Proficient with Microsoft Office including Word, Outlook and Excel

  • Ability to work independently under general instructions and with a team

  • Valid driver's license and/or dependable transportation necessary (variable by region)

Role Desirables

  • Education: BSN or Bachelor’s degree in a related field

  • Health Plan experience

  • Previous Medicare Experience

  • Strongly Prefer Previous experience in utilization review

Additional Information

Interview Format

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: Acute Onsite RN - Utilization Review

Location: KY-Louisville

Requisition ID: 178396