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  • Knoxville, TN

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Utilization Management Nurse 2

Humana • Knoxville, TN

Posted 11 days ago

Job Snapshot

Full-Time
Healthcare - Health Services, Insurance
Health Care, Insurance

Job 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.

Job Requirements

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

  • Bachelor's degree
  • 3+ years of clinical/utilization management experience in a healthcare setting
  • 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

Preferred Qualifications

  • Education: BSN or Bachelor's degree in a related field
  • Health Plan experience
  • Previous Medicare/Medicaid Experience a plus
  • Bilingual is a plus

Additional Information

Scheduled Weekly Hours

40

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