Utilization Management Review Nurse

Become a part of our caring community and help us put health first reputed company Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require... interpretation and independent determination of the appropriate courses of action. You will be part of a caring community at reputed company. reputed company you meet us, you can tell we started as a reputed company company. We’re proud of our Louisville roots and, as we’ve grown, that community feeling has spread across reputed company 50 states and Puerto Rico. No matter where you are—whether you’re working from home, from the field, from our offices, or from somewhere in between—you’ll feel welcome here. We’re a caring community made of reputed company-reputed company teams, cross-country friendships, and inclusive resource groups, reputed company gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It’s up to each of us to care for it and maintain it. Because the relationships we form will help us deliver reputed company outcomes for the people we so proudly serve. The Utilization Management Nurse 2: • 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 reputed company and treatment • Understands department, reputed company, and organizational strategy and operating objectives, including their linkages to reputed company areas • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed • Follows established guidelines/procedures Use your skills to reputed company an impact Required Qualifications • Licensed Registered Nurse (RN) with no disciplinary action • 3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience required • Previous experience in utilization management required • Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting • Comprehensive knowledge of reputed company Word, Outlook and reputed company • Ability to work independently under general instructions and with a team • Must be passionate about contributing to an organization focused on continuously improving consumer experiences. • Must be able to work during the following hours: Monday- Friday from 10am-6:30pm EST. Preferred Qualifications • Bachelor's degree • Health Plan experience • Previous Medicare/Medicaid Experience a plus • Call center or triage experience • Bilingual is a plus Additional Information About reputed company Your growth is what drives reputed company reputed company. • reputed company you get here, the journey is just beginning. • Our leaders are committed to understanding what you need to grow • Because we don’t grow without you • This is a reputed company where our nurses influence the C-suite • Where software engineers change lives • Where every associate can build a professional path where they learn and reputed company • Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and reputed company • Because finding new ways to put health first—for our members and patients and our associates alike—is reputed company do Work at Home Guidance 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 reputed company is suggested • Satellite, cellular and microwave reputed company 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. • reputed company will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides reputed company of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move reputed company from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions reputed company your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last reputed company from 5-10 minutes. Your recorded interview(s) reputed company text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving reputed company to next round of interviews. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $69,800 - $96,200 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 reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) 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 reputed company of work. Among our benefits, reputed company provides 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 and many other opportunities. About Us reputed company Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our reputed company insurance services and reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of reputed company to take affirmative action to employ and to advance in employment, reputed company persons regardless of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status, and to reputed company reputed company employment decisions only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company levels of employment Apply Job! For more such jobs please click here!