Utilization Management RN - Physical Health

Become a part of our caring community   Why Humana? At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we've got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future. Fostering a culture of inclusion is part of the fabric of who we are. We must have a workplace that reflects the people we serve and thrives in part because every person can bring their whole self to work to make an impact. Our vibrant, diverse culture and environment of inclusion is one of our greatest strengths. About Humana Healthy Horizons Humana Healthy Horizons is more than a health plan. We're human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health. The Utilization Management (UM) Nurse uses clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. The Utilization Management Nurse 2's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Position Responsibilities: • Use clinical knowledge toward interpreting criteria and procedures to provide the best and most appropriate treatment, care, or services for Enrollees • Coordinate and Communicate with Providers, Enrollees or other parties to facilitate optimal care and treatment • Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas • Use judgment regarding own work methods, occasionally in ambiguous situation, and receiving guidance where needed • Follow established guidelines and procedures • Periodic travel to Humana Oklahoma City office for meetings and training Use your skills to make an impact   Required Qualifications: • Must Reside in Oklahoma • An active Licensed Registered Nurse (RN), unrestricted • 3+ years of prior clinical experience, preferably in an acute care, skilled or rehabilitation clinical setting • Comprehensive knowledge of Microsoft Excel and Outlook • Ability to work a weekend rotation Preferred Qualifications: • Previous experience in Utilization Management • Prior experience with EPIC Programs • Previous remote work experience Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.   Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.   $71,1