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About this job
Become a part of our caring community and help us put health first
Utilization Management Nurse – Weekend Front End Review 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.
4 X 10’s Thursday- Sunday, 7am-6pm Eastern Time Zone
How we Value You
Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being
The Utilization Management Nurse – Weekend Front End Review 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.
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Utilize MCG criteria to perform acute concurrent front-end reviews on Humana members to determine medical necessity.
Use your skills to make an impact
Required Qualifications
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Licensed Registered Nurse (RN) in Florida with no disciplinary action.
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3 or more years of clinical experience preferably in an acute care- inpatient hospital setting.
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Proficiency using MS Office, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
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Ability to work independently under general instructions and with a team
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Strong general computer skills in an autonomous work setting.
Requirements/Adherence
Workstyle: Remote Work at Home
Location: Supporting Florida Market
Hours: Must be able to work Saturday through Tuesday 7:00 AM 6:00 PM Eastern Time and work 2 holidays annually
Travel: None
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:
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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
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Satellite, cellular and microwave connection can be used only if approved by leadership
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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.
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Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
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Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications
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Bachelor's degree
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Front End Review experience
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Previous experience in Utilization Management
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CGX experience
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MCG experience
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Health Plan experience
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Previous Medicare/Medicaid Experience
Additional Information
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, 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.
$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
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.
At Humana, caring is everything
And when you work here, you feel it. It’s how you grow. It’s how you’re welcomed into the associate community. It’s what guides us in putting health first. And it forms the connection each of us have for the people we serve.
Humana is at the nexus of the innovation taking place within healthcare. Broadly speaking, we are one of the most active participants in the sector. This is an exciting company headquartered in a city with an excellent quality of life!
Director, Corporate Development and Venture Capital
I looked for the opportunity for growth and stability and I found it here.
Director, Associate Experience Product Team
Humana has really helped my sense of belonging because I feel part of the team.
Senior Consumer Experience Professional
I chose to work at Humana because I heard a lot of great things about the company. It’s a very accommodating place and I enjoy working here.
Inbound Contact Representative
The best part of this company is the commitment to associates, which naturally leads to commitment to members.
Medical Director, Mid-South
Request an Accommodation
If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.
Employment Fraud Notice
Humana will never ask a candidate for money for work equipment and network access or request access to personal accounts during the application process. Learn more about identifying and preventing employment fraud or report a suspected employment fraud case.
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Benefits starting day one
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Health plan incentives
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Generous 401K match, financial planning services and a bonus structure that includes an Associate Incentive Plan.
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At Humana, caring is everything
Your growth drives us forward
When you get here, the journey is just beginning. We want to help you take charge of your path, no matter what shape it takes.
You’re welcome here
We pride ourselves on being a place where, no matter who you are, where you come from, or what you do, you feel that you belong.
Together, we put health first
Every day, we work together to apply our collective insight, talent, and creativity to improving people’s long-term health. And you can too.
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Work alongside people who have a common passion to care for people who need it.
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Our Hiring Process
Apply online
To be considered for a job, you must apply online. Unfortunately, we cannot accept resumes that have been emailed to us. Once you find a job that interests you, simply select “Apply.” It typically takes 15 minutes to fill out the application form. Be sure to update your resume and upload it as you cannot edit the resume or add it after the application has been submitted. Shortly after you submit your application, you will receive a confirmation.
Next Step
If selected to continue with the interview process, you will be contacted through text or email to complete an assessment or schedule an initial live or recorded phone or video interview.
A hiring manager interview
After hiring managers and interview teams carefully consider the skills and experiences of applicants, they contact the top candidates via email or phone to schedule an interview.
Offer from Humana
If you’ve successfully completed the interview process and are identified as the candidate we would like to hire, you will receive an offer from our Talent Acquisition team.
Onboarding
If you accept the offer to join our Humana team, you will receive a welcome call or email to begin the onboarding process.
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