Humana Utilization Management Nurse for SNF Program (RN) - Work at home - CA or NV only in Torrance, California

Role: Utilization Management Nurse for SNF Program, RN

Assignment: Medicare

Location: Work at home in CA or NV only

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 a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.

Humana is seeking a UM Nurse for the SNF (Skilled Nursing Facility) Program who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.

The ideal candidate for this position will live in either California or Nevada with a dual RN license preferred; have excellent presentation skills; experience working in skilled nursing facilities; a clinical background in case management and utilization management; solid computer skills; and the ability to travel 25-50% of the time throughout CA and NV while visiting SNF's to evaluate their level of service as it meets Humana's high standards of care for our members.

Responsibilities include:

  • 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 either CA or NV; dual license preferred

  • Ability to be licensed in multiple states without restrictions

  • Prior clinical experience in a skilled nursing facility setting

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

  • Valid drivers license and/or dependable transportation necessary (variable by region)

  • Computer proficient in Word, Excel, Outlook and PowerPoint

  • 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.

  • 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 for Humana systems is 10Mx1M

Role Desirables

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

  • Health Plan experience

  • Previous Medicare/Medicaid Experience a plus

  • Call center or triage experience

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

  • Bilingual is a plus

Additional Information

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.

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 (please be sure to check your spam or junk folders often to ensure communication isn’t missed) 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.

Title: Utilization Management Nurse for SNF Program (RN) - Work at home - CA or NV only

Location: CA-Torrance

Other Locations: US-NV-Las Vegas

Requisition ID: 179895

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.