Onsite Acute Utilization Management Nurse 2 – Aurora St. Luke’s, Milwaukee, WI – Humana – Green Bay, WI

The Utilization Management Nurse 2 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.

Responsibilities

The Utilization Management Nurse 2 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. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

• Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
• 3-5 years of clinical experience in an acute care hospital clinical setting
• Case Management experience is required
• Comprehensive knowledge of Microsoft Office, Word, Outlook and Excel
• Excellent communication skills both verbal and written
• Positive attitude and ability to adapt to change quickly
• Ability to work independently under general instructions and with a team
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• This role is considered patient facing and is part of Humana/Senior Bridge’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
• 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 10×1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

• Education: BSN or Bachelor’s degree in a related field
• Previous experience in utilization management
• Milliman MCG guidelines experience
• Health Plan experience
• Previous Medicare/Medicaid experience a plus
• Home Health experience

Additional Information

• Hours for this role are: Monday-Friday 8am-5pm CST
• This role is located onsite for part of the day at Aurora St. Luke’s in Milwaukee, WI and the remainder of the day will be work at home
• 
  Currently this role is full time work at home all day due to COVID-19 and will remain so until it is considered safe for associates to be onsite at healthcare facilities once again

Scheduled Weekly Hours

40