利用管理护士
Utilization Management Nurse
成为我们关怀社区的一员
利用管理护士 2 运用临床护理技能，支持医疗保健服务和/或福利管理决定的协调、记录和沟通。利用管理护士 2 的工作内容多样，通常需要对适当的行动方案进行解释和独立判断。该职位运用临床知识、沟通技巧和独立的批判性思维技能，以解读标准、政策和流程，为成员提供最佳且合适的治疗、护理或服务。与供应商、成员或其他相关方协调并沟通，以促进最佳的护理和治疗。您将向护理管理经理汇报，并支持医疗补助护理管理团队。
在此职位中，您将：
- 理解部门、业务单元和组织的战略及运营目标，包括其与其他相关领域的联系。
- 在偶尔存在模糊情况时，对自己的工作方法做出决策，需要最少的指导，并在需要时接受指导。
- 遵循既定的指南/流程。
利用您的技能产生影响
所需资格
- 持有路易斯安那州有效执照的注册护士（RN），无任何纪律处分，并具备在多个州执业的能力
- 3年以上多样的注册护士工作经验
- 熟悉 Microsoft Word、Outlook 和 Excel
- 能够在一般指导下独立工作，并与团队合作
- 地点：必须居住并在路易斯安那州内开展工作
- 工时：能够每周工作40小时，周一至周五上午8:00至下午5:00（中部时间），可能需要加班和周末轮班以满足业务需求
优先资格
- 教育：护理学士（BSN）或相关领域的学士学位
- 具有利用管理审查和/或事先授权的经验
- 具有健康计划经验
- 具有医疗保险/医疗补助经验者优先
- 具有 MCG 指南经验
- 有互认护理执照
附加信息
工作方式：居家远程办公
地点：必须居住并在路易斯安那州内开展工作
时间安排：大多数时区周一至周五上午8:00至下午5:00，可根据业务需求加班或在周末工作。
培训：培训项目将持续大约四到六周，课程时间安排为上午8:00至下午5:00。
查看英文原文
Become a part of our caring community
The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services 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.This role 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 members.
Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
You will report to the Manager Care Management and support the Medicaid CM Team.
In this role you will:
- Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
- Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
- Follows established guidelines/procedures.
Use your skills to make an impact
Required Qualifications
- Licensed Registered Nurse (RN) in the state of Louisiana with no disciplinary action with the 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
- Location: Must reside and conduct work in the state of Louisiana
- Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM Central Time, over-time and a weekend rotation may be requested to meet business needs
Preferred Qualifications
- Education: BSN or Bachelor's degree in a related field
- Experience in Utilization Management Review and/or Prior Authorization
- Health Plan experience
- Previous Medicare/Medicaid experience a plus
- Experience with MCG guidelines
- Compact Nursing License
Additional Information
Workstyle: Remote work at home
Location: Must reside in and perform work in the state of Louisiana
Schedule: Monday through Friday 8:00 AM to 5:00 PM in most time zones, with ability to work over-time, weekends as needed to support business needs.
Training: The training program will span approximately four to six weeks, with sessions scheduled from 8:00 AM to 5:00 PM. Additional virtual training opportunities will also be provided.
WAH Internet Statement
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 required.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- 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.
Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH's Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)
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
40Pay 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 yearThis 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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.
Originally posted on Himalayas