SNF Utilization Management Registered Nurse. Job in Providence Allied-IT Jobs in North Seekonk, MA
Job Description
Join our dedicated community and help us prioritize health! The Utilization Management Nurse plays a crucial role in supporting the coordination, documentation, and communication of medical services along with benefit administration determinations. In this role, you will leverage your clinical nursing skills to navigate varied assignments that often require independent decision-making and interpretation.
As a Utilization Management Nurse, you will utilize your clinical knowledge, excellent communication skills, and critical thinking to assess criteria, policies, and procedures in order to provide the best treatment and care for members. You will work collaboratively with providers, members, and other stakeholders to ensure optimal care and treatment outcomes.
In this role, you will:
• Demonstrate strong decision-making regarding work methods with minimal guidance.
• Follow established guidelines and procedures while adapting to varied situations.
• Strive for continuous improvement in consumer experiences.
Required Qualifications
• Active Registered Nurse (RN) License in the appropriate state with no disciplinary action.
• Must possess a Compact License.
• Over one year of clinical RN experience in an acute care setting, with preference for critical care, emergency room, or trauma units.
• Proficient in Microsoft Word, Outlook, and Excel.
• Ability to work both independently and collaboratively within a team.
• Passionate about contributing to an organization focused on improving consumer experiences.
Preferred Qualifications
• Education: BSN or a related bachelor’s degree.
• Three or more years of clinical experience in an acute care environment with a focus on critical care, emergency room, or trauma units.
• Experience as an MDS Coordinator or discharge planner within acute care settings.
• Prior experience in utilization management or review at health plans or acute care settings.
• Compact license along with single state RN licensure in California, Hawaii, Nevada, or Oregon.
• Experience in a Health Plan environment.
• Medicare/Medicaid experience is advantageous.
• Experience in call centers or triage settings.
• Bilingual candidates are encouraged to apply.
Additional Information
• Scheduled Weekly Hours: 40
• Travel Requirement: This is a remote position, but occasional travel to Humana's offices for training or meetings may be necessary.
If hired, you must provide a high-speed DSL or cable modem for your home office as satellite and wireless internet services are not allowed. A minimum standard of 25mbs download and 10mbs upload speed is required. Please also ensure you have a dedicated office space free from interruptions to maintain productivity and protect member PHI/HIPAA information.
Compensation
The estimated compensation range for this full-time position is $71,100 - $97,800 per year, depending on geographic location and individual qualifications.
Benefits
As part of Humana, we offer a comprehensive benefits package that supports your overall well-being. Our benefits include medical, dental, and vision coverage, a 401(k) retirement plan, paid time off, short and long-term disability, and life insurance, among others.
About OneHome
OneHome offers a coordinated range of post-acute care services, including home health and durable medical equipment, focused on creating a single point of accountability throughout the healthcare continuum. We are committed to an inclusive and diverse workplace culture that supports both personal and professional growth.
About Humana
Humana Inc. is dedicated to putting health first, working to ensure our members receive the best care possible. We are proud to serve various populations, including those with Medicare and Medicaid, while promoting better health outcomes and quality of life.
Equal Opportunity Employer
Humana does not discriminate against any employee or candidate based on race, color, religion, gender, sexual orientation, national origin, age, disability, or veteran status. We adhere to all civil rights laws and provide free language interpreter services.
As a Utilization Management Nurse, you will utilize your clinical knowledge, excellent communication skills, and critical thinking to assess criteria, policies, and procedures in order to provide the best treatment and care for members. You will work collaboratively with providers, members, and other stakeholders to ensure optimal care and treatment outcomes.
In this role, you will:
• Demonstrate strong decision-making regarding work methods with minimal guidance.
• Follow established guidelines and procedures while adapting to varied situations.
• Strive for continuous improvement in consumer experiences.
Required Qualifications
• Active Registered Nurse (RN) License in the appropriate state with no disciplinary action.
• Must possess a Compact License.
• Over one year of clinical RN experience in an acute care setting, with preference for critical care, emergency room, or trauma units.
• Proficient in Microsoft Word, Outlook, and Excel.
• Ability to work both independently and collaboratively within a team.
• Passionate about contributing to an organization focused on improving consumer experiences.
Preferred Qualifications
• Education: BSN or a related bachelor’s degree.
• Three or more years of clinical experience in an acute care environment with a focus on critical care, emergency room, or trauma units.
• Experience as an MDS Coordinator or discharge planner within acute care settings.
• Prior experience in utilization management or review at health plans or acute care settings.
• Compact license along with single state RN licensure in California, Hawaii, Nevada, or Oregon.
• Experience in a Health Plan environment.
• Medicare/Medicaid experience is advantageous.
• Experience in call centers or triage settings.
• Bilingual candidates are encouraged to apply.
Additional Information
• Scheduled Weekly Hours: 40
• Travel Requirement: This is a remote position, but occasional travel to Humana's offices for training or meetings may be necessary.
If hired, you must provide a high-speed DSL or cable modem for your home office as satellite and wireless internet services are not allowed. A minimum standard of 25mbs download and 10mbs upload speed is required. Please also ensure you have a dedicated office space free from interruptions to maintain productivity and protect member PHI/HIPAA information.
Compensation
The estimated compensation range for this full-time position is $71,100 - $97,800 per year, depending on geographic location and individual qualifications.
Benefits
As part of Humana, we offer a comprehensive benefits package that supports your overall well-being. Our benefits include medical, dental, and vision coverage, a 401(k) retirement plan, paid time off, short and long-term disability, and life insurance, among others.
About OneHome
OneHome offers a coordinated range of post-acute care services, including home health and durable medical equipment, focused on creating a single point of accountability throughout the healthcare continuum. We are committed to an inclusive and diverse workplace culture that supports both personal and professional growth.
About Humana
Humana Inc. is dedicated to putting health first, working to ensure our members receive the best care possible. We are proud to serve various populations, including those with Medicare and Medicaid, while promoting better health outcomes and quality of life.
Equal Opportunity Employer
Humana does not discriminate against any employee or candidate based on race, color, religion, gender, sexual orientation, national origin, age, disability, or veteran status. We adhere to all civil rights laws and provide free language interpreter services.
Job Details
Employment Type
Full-time
Required License
RN (Registered Nurse)
Years of Experience
Intermediate
Work Setting
Skilled nursing facilityAcute care
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About Humana
Humana Inc. is a health and well-being company in the United States, offering medical and supplemental benefit plans to individuals and employer groups. The company operates through three segments: Retail, Group and Specialty, and Healthcare Services, providing a range of health insurance benefits, pharmacy solutions, provider services, and home health services to its members. With approximately 17 million members in medical benefit plans and 5 million in specialty products, Humana serves individuals, employer groups, and government programs, including Medicare and Medicaid.