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RN Utilization Management Nurse - Medicaid - Multiple Office Locations

humanaservices Louisville, KY
  • Posted: 25 days ago
  • Other

Required Qualifications

Licensed Registered Nurse (RN) in the state of Kentucky with no disciplinary action and ability to hold licenses in multiple states without restriction.

2+ Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting

Strong Proficiency with MS Office Suite to include Word, Excel, Power Point,

2+ years Technical experience aptitude to troubleshoot and resolve system platform and connectivity problems

Experience with the development and implementation of policies and procedures

Ability to work independently under general instructions and with a team

Additional Requirements:

Hours: Typically an 8 hours shift Monday-Friday between 8:00 AM and 5:00 PM Central Time with rotating on-call coverage and oversight during weekends and holidays.

Primary Location: Louisville Kentucky Additional Locations: Covington, Lexington, Bowling Green

Travel: This role is an agile workstyle with a combination telephonic in an office and may anticipate visiting onsite facilities depending on the supported region. Travel may be required up to 3 days a week depending on location.

Transportation and Insurance Requirements: Valid driver's license, car insurance, and access to an automobile. This role is a part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Tuberculosis Screening: In the event that this role is requires facility visits or is patient facing within your region, you will be required to screen for TB as part of Humana's Tuberculosis (TB) screening program.

Work Style: This position is a combination office and remote/agile work based environment and will require the following:

  • Must ensure absolute and continuous privacy while you work within a home office or other remote location.
  • Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)

Preferred Qualifications

Bachelor's Degree

1+ year in-hospital Utilization Management experience

MCG experience

1+ year Care Management experience in an acute care, skilled or Rehabilitation clinical setting

Certified Case Manager, CCM

Health Plan experience

Medicaid experience

Call center or triage experience

Ability to work in multiple states without restriction

Bilingual is a plus - Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages before placing on a dedicate line to service our members.

Additional Information:

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

humanaservices

Address

Louisville, KY
USA

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