Utilization Management Registered Nurse - Weekend Front End Review - Remote Work Opportunity

Join Our Team as a Weekend Utilization Management Registered Nurse Are you a dedicated and compassionate Registered Nurse looking for a new challenge? Do you have a passion for delivering high-quality patient care and making a positive impact on the healthcare system? Look no further! We are seeking an experienced Utilization Management Registered Nurse to join our team on a remote basis. As a Weekend Utilization Management Registered Nurse, you will play a critical role in supporting the coordination, documentation, and communication of medical services and benefit administration determinations. About Our Company and Culture At Humana, we are committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. Our company culture is built on a foundation of compassion, integrity, and respect, and we strive to create a work environment that is engaging, challenging, and rewarding for all our employees. Job Summary As a Weekend Utilization Management Registered Nurse, you will utilize your clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. You will work independently to interpret and apply clinical criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for our members. Your primary responsibilities will include: Utilizing MCG criteria to perform acute concurrent front-end reviews on Humana members to determine medical necessity Coordinating and communicating with providers, members, or other parties to facilitate optimal care and treatment Interpreting and applying clinical criteria, policies, and procedures to provide high-quality patient care Working independently under general instructions and with a team to achieve departmental goals Troubleshooting and resolving basic technical difficulties in a remote environment Requirements and Qualifications Essential Qualifications: Licensed Registered Nurse (RN) in Florida with no disciplinary action 3 or more years of clinical experience, preferably in an acute care inpatient hospital setting Proficiency using MS Office, navigating multiple systems and platforms, and ability to troubleshoot and resolve basic technical difficulties in a remote environment Ability to work independently under general instructions and with a team Strong general computer skills in an autonomous work setting Preferred Qualifications: Bachelor's degree Front End Review experience Previous experience in Utilization Management CGX experience MCG experience Health Plan experience Previous Medicare/Medicaid Experience What We Offer At Humana, we value our employees and offer a comprehensive benefits package that supports whole-person well-being. Our benefits include: Competitive salary: $69,800 - $96,200 per year Benefits starting day 1 of employment Competitive 401(k) match Generous Paid Time Off accrual Tuition Reimbursement Parent Leave Go365 perks for well-being 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 Work Environment and Culture As a remote employee, you will have the flexibility to work from home and enjoy a better work-life balance. Our company culture is built on a foundation of compassion, integrity, and respect, and we strive to create a work environment that is engaging, challenging, and rewarding for all our employees. We offer: Remote work opportunity Flexible scheduling Autonomous work environment Opportunities for professional growth and development Collaborative and supportive team Career Growth Opportunities and Learning Benefits At Humana, we are committed to helping our employees grow and develop their skills. We offer: Opportunities for professional growth and development Training and education programs Tuition reimbursement Leadership development programs How to Apply If you are a motivated and compassionate Registered Nurse looking for a new challenge, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and cover letter, to: Interview Process As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. Equal Opportunity Employer Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. We are an equal opportunity employer and welcome applications from diverse candidates. It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. Apply for this job