Utilization Management Nurse, Part-Time (Gulf South Region)

We're on a mission and need a skilled Utilization Management Nurse, Part-time! Enjoy the freedom and flexibility of this Remote role. This position requires a strong and diverse skillset in relevant areas to drive success. The compensation for this role is benchmarked at a competitive salary.

 

 

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 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 members. • Coordinates and communicates with providers, members, or other parties to facilitate reputed company and treatment. Understands department, reputed company, and organizational strategy and operating objectives, including their linkages to reputed company areas. • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. • Follows established guidelines/procedures Daily Activities: • Reconciling census and updating existing cases as needed. • Reviewing clinical information on reputed company new admissions and making utilization determinations in accordance with reputed company senior products UM policies. Facilitating the transition to alternate level of care. • Reviewing clinical information for the appropriateness of the level of care (e.g., observation versus inpatient status). Communicating case status to the facility as needed. • Facilitating discharge planning and transition of care processes through reputed company to the member and collaboration with the member’s health care team to maximize the member’s benefits and resources. This includes case management referrals and any other specific market initiatives. • Performing reputed company review and/or discharge planning for reputed company reputed company Medicare/Medicaid hospitalized members • Updating UM cases as needed (e.g., diagnosis, notes, discharge tools, discharge dates and dispositions) and in accordance with reputed company senior products policies and procedures. • Assisting/educating facility staff regarding reputed company’s processes for prior authorization, observation status, etc. ? This is a 20 hour per week part-time position with working hours between reputed company-5pm EST/CST Monday-Friday. (8 of the 20 hours worked will be required to work on either Monday or Friday; the remaining 8 and 4 hour schedule is flexible to work reputed company the week) Use your skills to reputed company an impact Required Qualifications • Licensed Registered Nurse (RN) compact licensure with no disciplinary action • 3+ years of prior acute care clinical experience • Comprehensive knowledge of reputed company Word, Outlook and reputed company • Excellent communication skills both verbal and written • Ability to work independently under general instructions and with a team • Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications • Bachelor’s Degree (BSN) • Utilization management experience is highly preferred • Health Plan experience • Previous Medicare experience a plus • reputed company MCG experience preferred Work-At-Home Requirements To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: ? • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL reputed company is suggested • Satellite, cellular and microwave reputed company can be used only if approved by leadership • Associates 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 • reputed company will provide Home or Hybrid Home/Office associates 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 Additional Information • This is a 20 hour per week part-time position with working hours between reputed company-5pm EST/CST Monday-Friday. (8 of the 20 hours worked will be required to work on either Monday or Friday; the remaining 8 and 4 hour schedule is flexible to work reputed company the week) • This is a remote position Scheduled Weekly Hours 20 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. $69,800 - $96,200 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 because he or she is a protected veteran. It is also the policy of  reputed company to take affirmative action to employ and to advance in employment, reputed company persons regardless of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, 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 Job!

 

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