Humana is looking for a Utilization Management Nurse to join our Florida LTSS (Long Term Supports and Services) program. In this role, you will apply your clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. Work assignments are varied and will frequently require your independent interpretation and critical thinking to determine the best course of action.
What You'll Do
- Utilize clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures.
- Provide the most appropriate treatment, care, or services for members.
- Coordinate and communicate with providers, members, and other parties to facilitate optimal care.
- Understand and align with department, segment, and organizational strategies.
- Make decisions regarding your own work methods, occasionally in ambiguous situations.
- Follow established guidelines and procedures.
What We're Looking For
- Active Licensed Practical Nurse (LPN) or Licensed Registered Nurse (RN) in the state of Florida with no disciplinary action.
- Minimum of one (1) year of LTSS (Long Term Supports and Services) experience.
- Previous experience in utilization management.
- Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
Nice to Have
- Bachelor's degree.
- Previous Medicare/Medicaid experience.
- Previous case management experience.
- Previous CGX experience.
- MCG certification.
Technical Stack
- Microsoft Word
- Microsoft Outlook
- Microsoft Excel
Benefits & Compensation
- Compensation: $71,100 - $97,800 per year.
- Health benefits effective day 1.
- Paid time off, holidays, volunteer time, and jury duty pay.
- Recognition pay.
- 401(k) retirement savings plan with employer match.
- Tuition assistance.
- Scholarships for eligible dependents.
- Parental and caregiver leave.
- Employee charity matching program.
- Network Resource Groups (NRGs).
- Career development opportunities.
Work Mode
This is a hybrid position based in Florida.
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 protected veteran status.
