• Humana
  • Cleveland, OK
  • Healthcare - Nursing
  • Full-Time
  • 369230 Old Highway 64

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Description

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.

Responsibilities

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.

Required Qualifications

  • Bachelor's Degree or equivalent
  • 6 yearsas RN with diverse clinical experience (acute care, post-acute care, home health)
  • 4 years of management experience
  • Licensed Registered Nurse (RN) with no disciplinary action
  • 3 years of Home Health experience
  • Ability to work independently and exercise appropriate judgement
  • Ability to manage teams while simultaneously managing own work responsibilities to meet deadlines
  • Excellent communication skills
  • Effectively manage employee mentoring and disciplinary actions
  • Preferred Qualifications

  • Health Plan experience
  • Prior Medicare / Medicaid experience
  • Prior telephonic care experience
  • Bilingual is a plus
  • Additional Information

    This position is Work at Home. Ideal candidate should live in Central Region, preferrably in the States of OK, AR, KS or MS.

    The hourse are 8-5 Central Time.

    Scheduled Weekly Hours

    40

    * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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