Acute Utilization Review Nurse (Front End Review)
Location: Louisville, Kentucky
Description: Humana is currently seeking to employ Acute Utilization Review Nurse (Front End Review) right now, this position will be placed in Kentucky. More complete informations about this position opportunity please give attention to these descriptions. Be a part of our Clinical Space â€" as a Acute Utilization Review Nurse (Front End Review) RN you will engage our members to develop lifelong wellbeing and health.
Humana is seeking a Acute Utilization Review Nurse (Front End Review) RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.
Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design
Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally
Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols
Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria
Conduct admission review, post-discharge calls and discharge planning
Role Essentials
Active RN license in the state(s) in which the nurse is required to practice
Prior clinical experience in an acute care clinical setting minimum 3-5 years
Positive Attitude
Proficient in computer technology and experience with Microsoft Office product Excel, Outlook, Word, Skype, etc.
Valid driver’s license and/or dependable transportation necessary
Role Desirables
Education: BSN
Health Plan experience
Previous Medicare experience a plus
Experience with MCG (Formerly Milliman) or Interqual
Previous experience in utilization management
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 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.
Humana is an organization with careers that change livesâ€"including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to Humana.
Interested on this position, just click on the Apply button, you will be redirected to the official website
Apply Acute Utilization Review Nurse (Front End Review) Here
This position will be started on: Mon, 22 Jan 2018 21:12:32 GMT
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