Utilization Management Coordinator Jobs in Rochester, WA

Become a part of our caring community

Job Description Summary

The Clinical Care Nurse Educator plans, directs, coordinates, evaluates, develops, and/or delivers training and education programs for professional nursing personnel. The Clinical Care Nurse Educator work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. This role will report to the Associate Director of Clinical Education under the leadership of the National AVP, Clinical Education.

Role Description

• The Clinical Care Nurse Educator works within the Clinical Education team and is focused on training and educating clinical staff that support our PCO centers, focused on Clinical Care Nurses.

• Working within an interdisciplinary care team, the Clinical Care Nurse is responsible for proactively engaging patients identified as high-risk and implementing targeted interventions to address multi-complexity medical and social needs and increase access to care. The Clinical Care Nurse will provide guidance and oversight of care coordination efforts to other members of the team, and handle clinical escalations as indicated.

• The Clinical Care Nurse Educator has a deep understanding of all the High-Risk Patient Management (HRPM), Transitional Care Management (TCM) program, and STARS quality measures to ensure that care integration staff can apply value-based care and population health principles effectively within their daily work. This knowledge enables the Clinical Care Nurse Educator to gain the respect and confidence of their peers as a peer educator.

Primary Responsibilities :

• Develop, plan, organize, and supervise training for Clinical Care Nurses, care integration team members and primary care providers including principles of population health, value-based care, and senior care. Oversee training aspects of STARS Quality metrics, readmission risk, Chronic Disease Management, Medication Reconciliation, Care Giver Burnout, Advance Care Planning, and Suicide. May also need to incorporate EMR and systems training, Compliance, primary care policy and procedure, coding and documentation, quality, utilization, customer service standards, team effectiveness and communication as needed. Training could occur in-person in markets and virtually through live and recorded sessions.

• Serve as faculty for clinical staff learning journeys and provider onboarding as needed.

• Have knowledge on transitions of care best practices, creation and management of care plans, knowledge on 5M Geriatric best practices. Have strong Motivation Interviewing (MI) skills and be able to teach and facilitate sessions on how to gain these skillsets.

• Monitor medical performance through direct observation, listening to calls, chart review, data review, and provide guidance to ensure that the quality of care being provided meets appropriate standards and to ensure cost-effective utilization practices for new and current associates that require coaching or performance improvement plans.

• Supports the development of score cards to document Clinical Care Nurse work quality and completes score cards through direct observation, chart review and shares such data with education team, care integration team and other stakeholders on a regular basis. Supports preceptors and preceptor program to ensure smooth transition for new associates between national and market-based onboarding. Ensure licensed RNs meet competency requirements and assign modules for those who need education and training, in addition to shadowing and hands on work.

• Work collaboratively with Regional Directors, Program Delivery team, Compliance, market teams and PCO leadership to identify training needs for care integration team members.

• Represent the organization in recruiting and marketing events as needed.

• Maintain active clinical practice in the local market for a portion of the time. This is currently set to 10%.

• Serves as a key SME interviewer in future RN hires to promote standardized and consistent hiring approach.

• May serve as faculty for Activity Center topic of the month session or CIT Grand Rounds for CE credit as needed.

• Travel up to 20% for onsite training delivery, role observation, and clinical practice

Use your skills to make an impact

Required Qualifications

• RN License in home state

• Willingness to obtain licensure in additional states as needed

• Minimum of five years' experience working as a Registered Nurse

• Knowledge of community health and social service agencies and resources

• Experience working as part of an interprofessional team

• Experience in training and/or training content development

• Proficient in Microsoft Office, EMR systems, and Zoom

Preferred Qualifications

• Familiarity with state Medicaid guidelines and application processes preferred.

• Experience working with the geriatric/senior population

• Experience in care management program management or implementation

• Knowledge of EMR/documentation platforms including Salesforce and AthenaOne

• Knowledge of Team STEPPS evidenced-based standards

Key Competencies

• Clinical Workflow Expertise: You demonstrate up-to-date knowledge of relevant clinical workflows and protocols

• Training Delivery and Presentation: You facilitate engaging and structured didactic training sessions, utilizing available technology to maximize training effectiveness

• Content Development: You develop clear, relevant, and evidence-based training materials tailored to the role(s) you are supporting

• Communication and Leadership: You communicate and advocate effectively and professionally with clinical leadership and interprofessional teams. You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience

• Strategic Thinking & Systems Contribution: You provide meaningful input during program design discussions, including identifying opportunities for innovation and improvement. You are a problem solver with the ability to identify needs and drive the work with low to moderate oversight

• Clinical Knowledge Application : You apply clinical knowledge appropriately within a value-based care model

• during training or coaching

• Coaching & Staff Development: You support staff development through mentorship, role-modeling, reverse shadowing, and constructive strengths-based feedback

Additional Information

• Remote role

• Reside in an existing PCO market to support clinical practice within the market

• Ability to travel up to 20%, largely within local and regional markets

• Flexibility with work location; locations listed in job posting are preferred

Work from Home Requirements

• To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Benefits and Perks:

At Humana, we value our employees and are committed to providing a supportive and rewarding work environment. As a Senior Nursing Educator, you will enjoy a comprehensive benefits package designed to enhance your well-being and professional growth:

• Health and Wellness: Comprehensive health, dental, and vision insurance plans to keep you and your family healthy.

• Retirement Savings: Generous 401(k) plan with company match to help you plan for your future.

• Professional Development: Opportunities for continuous learning and development, including access to training programs, certifications, and tuition reimbursement.

• Work-Life Balance: Flexible work arrangements, including remote work options and paid time off to support your personal and professional life.

• Employee Assistance Program: Access to resources and support for personal, financial, and legal matters.

• Wellness Programs: Initiatives to promote physical and mental well-being, including fitness memberships and wellness challenges.

• Community Engagement: Opportunities to participate in volunteer activities and give back to the community.

• Recognition and Rewards: Programs to recognize and reward your contributions and achievements.

Join our team and make a difference in the lives of patients while advancing your career in a supportive and dynamic environment.

Impact on Patient Care:

As a Senior Nursing Educator, you play a pivotal role in transforming geriatric care within our value-based care model. Your expertise and dedication directly contribute to improving the health outcomes and quality of life for our senior patients, particularly those at high risk. Here's how your work makes a difference:

• High-Risk Patient Management (HRPM): By training and guiding RN Care Navigators and Outreach RNs, you ensure that our high-risk patients receive personalized, proactive care. This includes identifying and addressing complex medical and social needs, reducing hospital readmissions, and enhancing overall patient well-being.

• Transitional Care Management (TCM): Your role in educating the care team on best practices for transitions of care ensures that patients experience seamless and safe transitions between different care settings. This reduces the risk of complications and readmissions and supports patients in achieving better health outcomes.

• Geriatric Best Practices: By incorporating the 5M Geriatric best practices into training programs, you help the care team deliver age-appropriate, comprehensive care that addresses the unique needs of our elderly patients. This holistic approach promotes independence, dignity, and improved quality of life.

• Motivational Interviewing (MI): Teaching and facilitating sessions on MI skills empowers the care team to engage patients effectively, fostering trust and encouraging adherence to care plans. This patient-centered approach is crucial for managing chronic conditions and achieving long-term health goals.

• Quality and Utilization: By monitoring and guiding medical performance, you ensure that the care provided meets high standards of quality and cost-effectiveness. This not only improves patient outcomes but also supports the sustainability of our value-based care model.

Your contributions as a Care Navigator RN Clinical Educator are vital in shaping a healthcare environment where our senior patients receive the compassionate, coordinated, and high-quality care they deserve. Join us in making a meaningful impact on the lives of those we serve.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$86,300 - $118,700 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 08-30-2026

About us