Location: IN
Location Type: Remote
Schedule: Full_time
Req: R-345216

Become a part of our caring community and help us put health first

Humana Healthy Horizons in Indiana is seeking a Manager, Utilization Management (UM) Nursing who utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Manager, UM Nursing works within specific guidelines and procedures, applies advanced technical knowledge to solve moderately complex problems, and receives assignments in the form of objectives to determine approach, resources, schedules, and goals.

 

 

The Manager, UM 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.

 

Key responsibilities include but are not limited to:

• Operational responsibility for UM functions.
• People management responsibility of direct reports.
• Act as point of contact to coordinate pilots, changes, and initiatives across UM functions.
• Manage escalations from providers/members and internal partners.
• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Review metrics across UM spectrum and manage any unfavorable trends.
• Represent the region externally (UM) to Acute/Post-Acute and other healthcare systems.
• Delegation oversight along with other duties as assigned.

Use your skills to make an impact

Required Qualifications

• 3+ years of experience in utilization management.
• 2+ years of experience managing people and teams.
• Licensed Registered Nurse (RN) in the State of Indiana with no disciplinary action.
• 2+ years of experience working in a managed care or acute hospital setting.
• Ability to travel up to 10% in the state of Indiana.
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook

Work at Home Requirements

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

Preferred Qualifications

• Preferred residence in the State of Indiana.
• BSN or bachelor’s degree in nursing.
• Process improvement or project management experience.
• Experience working with LTSS authorizations.
• Background working with Medicare and Medicaid members.
• Passionate about contributing to an organization focused on continuously improving consumer experiences.

Additional Information:

• Workstyle: Remote but may vary due to occasional onsite work at the Humana Healthy Horizons office in Indiana.
• Travel: Up to 10% travel in the state of Indiana to Humana locations.
• Core Workdays & Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more…..

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

 

If you are selected to move forward 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 via 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 anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

 

 

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.

 

$84,600 – $116,300 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better 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 Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all 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 all levels of employment.