Join Our Caring Community as a Utilization Management Appeals Nurse 2 - Telephonic Remote
Are you a compassionate and detail-oriented Registered Nurse looking for a challenging yet rewarding role in healthcare? Do you have a passion for delivering high-quality patient care and making a positive impact on people's lives? If so, we invite you to join our team as a Utilization Management Appeals Nurse 2 - Telephonic Remote. At Humana, we're committed to putting health first for our teammates, customers, and communities. As a key member of our Utilization Management team, you'll play a critical role in ensuring that our members receive the best possible care and services.
About Humana and Our Commitment to Health
Humana Inc. (NYSE: HUM) is a leading health and well-being company dedicated to helping people achieve their best health. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to access quality care and services. Our goal is to deliver personalized, patient-centered care that addresses the unique needs of each individual. We're passionate about creating a healthier, more compassionate world, and we're looking for talented professionals like you to join our team.
Job Summary
As a Utilization Management Appeals Nurse 2 - Telephonic Remote, you'll utilize your clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. You'll work independently to interpret and apply clinical criteria, policies, and procedures to ensure that our members receive optimal care and services. Your expertise will help us make informed decisions about medical necessity, treatment, and care planning.
Key Responsibilities:
- Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations
- Interpret and apply clinical criteria, policies, and procedures to ensure that members receive optimal care and services
- Coordinate and communicate with providers, members, and other parties to facilitate care and treatment planning
- Make independent decisions about medical necessity, treatment, and care planning
- Work collaboratively with cross-functional teams to achieve department, segment, and organizational goals
- Stay up-to-date with changing regulations, policies, and procedures to ensure compliance and quality care
Requirements and Qualifications
Essential Qualifications:
- Bachelor's degree in Nursing or a related field
- Licensed Registered Nurse (RN) in the state of practice with no disciplinary action
- 3-5 years of medical-surgical, heart, lung, or critical care nursing experience
- Previous experience in utilization management, case management, or a related field
- Comprehensive knowledge of Microsoft Word, Outlook, and Excel
- Ability to work independently and as part of a team
- High-speed DSL or cable modem for home office (10x1 Mbps)
Preferred Qualifications:
- BSN or Bachelor's degree in a related field
- Health plan experience
- Previous Medicare/Medicaid experience
- Call center or triage experience
- Bilingual skills
Skills and Competencies
To succeed in this role, you'll need:
- Strong clinical knowledge and critical thinking skills
- Excellent communication and interpersonal skills
- Ability to work independently and make sound judgments
- Strong analytical and problem-solving skills
- Attention to detail and organizational skills
- Compassion, empathy, and a patient-centered approach
Career Growth Opportunities and Learning Benefits
At Humana, we're committed to helping our teammates grow and develop their skills. As a Utilization Management Appeals Nurse 2 - Telephonic Remote, you'll have access to:
- Comprehensive training and onboarding program
- Ongoing education and professional development opportunities
- Career advancement opportunities within the company
- Competitive salary and benefits package
Work Environment and Company Culture
We offer a supportive and inclusive work environment that values diversity, equity, and inclusion. Our company culture is built on:
- Compassion, empathy, and respect for our members and teammates
- Collaboration, teamwork, and open communication
- Innovation, creativity, and continuous improvement
- Accountability, transparency, and integrity
Compensation, Perks, and Benefits
We offer a comprehensive compensation package that includes:
- Competitive salary range: $69,800 - $96,200 per year
- Bonus incentive plan based on company and individual performance
- 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
Equal Opportunity Employer
Humana is an equal opportunity employer committed to diversity, equity, and inclusion. We welcome applications from qualified candidates of all backgrounds and perspectives.
Ready to Make a Difference?
If you're a motivated and compassionate Registered Nurse looking for a challenging yet rewarding role, we encourage you to apply for this exciting opportunity. Join our team as a Utilization Management Appeals Nurse 2 - Telephonic Remote and help us make a positive impact on the lives of our members.
Apply Now