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- Las Vegas, NV
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Manager, Utilization Managment Nursing
Humana • Las Vegas, NV
Posted 11 days ago
The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
The Manager, Utilization Management Nursing 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. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
- Bachelor's Degree or equivalent and 6+ years of technical and 2+ years of utilization management experience
- Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
- Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Ability to work independently under general instructions and with a team
- Prior supervisory experience highly preferred
- Health Plan experience
- Prior Medicare / Medicaid experience
- Call center or triage experience
- Bilingual is a plus
Scheduled Weekly Hours