Manager, Utilization Management Physical Health

Description

The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

Position Responsibilities

The Manager, Utilization Management 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.

• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
• Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

• An active Registered Nurse (RN) licensed in the state of Oklahoma without restrictions.
• BSN, Bachelor's degree in health services, healthcare administration, or business administration preferred.
• 2+ years of clinical supervisory experience.
• 2+ years of case management experience.
• 3+ years of post-degree clinical experience in direct patient care.
• Progressive clinical experience preferably in an acute care, skilled or rehabilitation setting.
• Previous experience in utilization management.
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
• Ability to work independently under general instructions and with a team.

• Experienced with Milliman or Interqual 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.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees 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 employees 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.

• Paid time off, holidays, volunteer time and jury duty pay, Recognition pay.
• 401(k) retirement savings plan with employer match.
• Tuition assistance, Scholarships for eligible dependents.
• Parental and caregiver leave.
• Employee charity matching program.
• Network Resource Groups (NRGs).
• Career development opportunities.