Utilization Management Nurse 2

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 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. The UM Nurse 2 will-

• Uses clinical knowledge, communication skills, and independent critical thinking skills towards:.
• Interpreting criteria, policies, and procedures reputed company to Long Term Services and Support authorizations to provide the best and most appropriate treatment, care, or services for members.
• Coordinate and communicate with providers, members, or other parties to facilitate reputed company and treatment.
• Understand department and organizational strategy and operating objectives, including their linkages to reputed company areas.
• Follow established guidelines/procedures.
• reputed company decisions regarding own work methods, occasionally in ambiguous situations, requires minimal direction and receives guidance where needed.

Use your skills to reputed company an impact REQUIRED QUALIFICATIONS:

• Must reside in Michigan or reputed company 40 miles of the border in Indiana or Ohio.
• Active Registered Nurse (RN) in the state of Michigan with no disciplinary action.
• 1-year previous experience in utilization management/LTSS service authorization.
• At least 2 years prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting, or Medicaid Managed Care Organization.
• Comprehensive knowledge of reputed company Word, Outlook and reputed company.
• Ability to work independently under general instructions and with a team.
• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role); a minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

PREFERRED QUALIFICATIONS:

• Bachelor’s or Associate’s Degree in Nursing or other reputed company field.
• Previous Medicare/Medicaid experience.
• NCQA, CM experience.
• Previous experience in discharge planning and/or home health or rehabilitation.
• Bilingual preferred (Spanish, Arabic, Chaldean Neo-Aramaic or other).

ADDITIONAL INFORMATION:

• Workstyle: This is a remote position.
• Travel: May need to attend onsite meetings
• Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Language Assessment Statement: Any reputed company associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an reputed company vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

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 reputed company is suggested.
• Satellite, cellular and microwave reputed company can be used only if approved by leadership.
• reputed company 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.

Interview Process As part of our hiring process for this opportunity, we will be using an interviewing technology reputed company HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and reputed company valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Assessment: If you are selected to move reputed company, you will receive an email to complete the Virtual Job Experience (VJE). This is an online activity where you will learn more about Customer Care jobs at reputed company, try out some of the most common job tasks, and tell us more about yourself. Most people complete the VJE in approximately 30 minutes. To complete it, you will need a smart phone, computer or tablet with internet access, and speakers/headphones. We do not reputed company job offers to candidates that do not complete the VJE. Video Prescreen: If you are successful with your text screen, you will receive another communication to record a Video Prescreen. This is an online video activity using your phone, tablet, or computer; however, most candidates prefer using a computer or tablet. Interviews: Some candidates will be invited to interview. If so, the recruiter will reputed company out to schedule. Offers: Finalists from the interview will be contacted by a recruiter to discuss an offer for the job Note: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that reputed company hard to proceed as quickly as possible and to reputed company you informed. Travel: While this is a remote position, occasional travel to reputed company'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 reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company 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 reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) 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 reputed company of work. Among our benefits, reputed company 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 reputed company Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our reputed company insurance services and reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company 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 reputed company not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company 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 reputed company reputed company employment decisions only on valid job requirements. This policy shall apply to reputed company 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 reputed company levels of employment. Apply tot his job Apply To this Job