Nomadic Career Services Forum Job Postings Healthcare RN – UR Telephonic Concurrent Review Nurse

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    Link To Job Posting: https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Work-at-Home-Virginia/RN—UR-Telephonic-Concurrent-Review-Nurse_R-217866

    Description

    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.
    Responsibilities

    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 optimal care and treatment. 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.

    Required Qualifications

    Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action.
    Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
    Comprehensive knowledge of Microsoft Word, Outlook and Excel
    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 10×1 (10mbs download x 1mbs upload) is required
    Preferred Qualifications

    3-5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
    Health Plan experience
    Previous Medicare/Medicaid Experience a plus
    Additional Information

    Scheduled Weekly Hours

    40

    apply

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