"Alerted.org

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, discharges 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 at an on-site facility. This position will have a limited hybrid with some hours working at home at leader discretion. Located within about a 30-minute driving distance to Lee Memorial Hospital from home base.

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 our Medicare members.

+ Coordinate and communicate with providers, members, case managers PCP or other parties to facilitate appropriate discharge planning, assist with social determinants and closing gaps to facilitate optimal care and treatment.

+ Identify barriers to discharge and avoidable readmissions

+ Understands department, segment, and organizational strategy and operating objectives, including how they interrelate to each area

+ Works independently, makes appropriate decisions, requires minimal direction and seeks guidance where needed

+ Evaluate and refer to other programs available to Member

+ Follows established guidelines/procedures

.

Use your skills to make an impact

Required Qualifications

+ RN License without restrictions in Florida or Compact state license.

+ Located about a 30-minute driving distance to Lee Memorial from home base.

+ 2 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting

+ Comprehensive knowledge of Microsoft Word, Outlook and Excel

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

+ Independent critical thinking skills

+ Strong Written and verbal communication skills

+ Valid Driver’s License and/or dependable transportation necessary

+ Travel to Hospital/Provider for on-site reviews to assist Members

+ This role is considered patient facing. If selected for this role, you will be required to meet criteria to be on-site with Providers/Hospitals/Health Care Facilities.

+ This position will have a limited hybrid with some hours working at home at leader discretion.

+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

+ Must have the ability to provide a high-speed DSL or cable modem for a home office. At minimum, a download speed of 25 Mbps and an upload speed of 25 Mbps is recommended; wireless, wired cable or DSL connection is suggested

+ Humana will provide Home or Hybrid Home/Office associates with computer/telephone equipment appropriate to meet the business requirements for their position/job

+ 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.

Preferred Qualifications

+ BSN or Bachelor's degree in a related field

+ Previous experience in discharge planning, utilization management or case management a plus

+ Health Plan experience

+ Previous Medicare/Geriatric Experience a plus

+ Bilingual is a plus

Scheduled Weekly Hours

40/wk.

Must be able to work 8:30 am-5pm EST M-F

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.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Employees 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.

Humana will provide Home or Hybrid Home/Office employees 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.

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.

$71,100 - $97,800 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

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision 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

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

​

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all 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 all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.