Utilization Management Nurse
New
H
HumanaHealthcare
United States, Central TimeFull-TimeMiddle
Salary$71,100 - $97,800 per year
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Job Details
- Experience
- 3+ years
- Required Skills
- Microsoft ExcelHIPAA
Requirements
- Licensed Registered Nurse (RN) in the state of Louisiana with no disciplinary action.
- Ability to be licensed in multiple states.
- 3+ years of varied RN nursing experience.
- Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
- Ability to work independently under general instructions and with a team.
- Must reside and conduct work in the state of Louisiana.
- Ability to work a 40-hour work week, Monday through Friday, 8:00 AM to 5:00 PM Central Time.
- Available for overtime and weekend rotation as needed.
- Self-provided internet service with minimum 25 Mbps download and 10 Mbps upload speed.
- Access to a dedicated work space to protect member PHI/HIPAA information.
Responsibilities
- Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations.
- Interpret criteria, policies, and procedures to provide appropriate treatment, care, or services for members.
- Coordinate and communicate with providers, members, and other parties to facilitate optimal care.
- Make independent clinical determinations and decisions regarding work methods.
- Support the Medicaid Care Management team and department strategy.
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