Utilization Management Nurse Lead - Remote FL

The Utilization Management Nurse Lead utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Utilization Management Nurse Lead 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.
• Advises executives to develop functional strategies (often segment specific) on matters of significance.
• Supports initiatives/projects that align with strategic objectives. Develop and lead prioritization process (e.g. intake, evaluation), identify trade-offs and make recommendations to leadership on selection to ensure the business is working on the right things.
• Monitoring and evaluating project progress. Define, align and track success metrics. Identify gaps and makes recommendations for improvement.
• Develop communications as needed including executive summaries, management reports, business presentations and trainings, and data visualization.
• Act as a strategic partner and build strong relationships with leaders, peers and internal businesses.
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision.
• Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Required Qualifications

• Bachelor's degree
• Current Unrestricted RN licensed in Florida with no disciplinary action
• 5 years working in healthcare
• 2 or more years of experience leading projects
• Proficient in Microsoft Office applications including Word, Excel, Outlook and PowerPoint
• Strong problem solving, data-analysis, and critical-thinking skills with the ability to operate and drive progress with limited information and ambiguity
• Strong presentation skills using PowerPoint and ability to communicate with all levels
• The hours for this position are 8AM- 5 PM Monday- Friday Eastern Time, with occasional overtime to support business needs.
• You will be expected on occasion to report to the Market office for meetings
• Must reside in Florida
• For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
• If progressed to offer, you will be required to:
  • Provide proof of full vaccination or commit to testing protocols OR
  • Provide proof of applicable exemption including any required supporting documentation
  • Medical, religious, state and remote-only work exemptions are available.

Work At Home Requirements

• Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.
• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

Preferred Qualifications

• Master’s degree in public health or MBA
• Consulting background

Additional Information

Onsite Travel

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process. #ThriveTogether #WorkAtHome

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. Modern Hire 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 Modern Hire 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.

Scheduled Weekly Hours

40