Humana utilization review nurse

The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members.

Apply now. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Creating Healthy Communities is good for the Soul. Join Us! 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.

Humana utilization review nurse

For people who specialize in care. Both organizations put the needs of the senior at the forefront of everything we do. Nurses and Social Workers make a difference in assisting members in achieving lifelong well-being. Nurses work throughout our organization in direct patient care, assessment, review or leadership capacities. Social Workers provide guidance for maintaining your social wellness, including things like financial health, access to food and medications, advanced directives and living wills. Our goal is to advance the intentional presence of nurses throughout Humana, creating a culture where nurses are valued, inspired and engaged. Our teams focus on the unique physical, social and emotional needs of seniors, with a whole-person approach to care. That means understanding individual needs, addressing chronic conditions and helping our patients thrive in their communities. Whether your area of expertise is clinical or more technical, when you join our team of physicians, you become a part of a balanced team focused on pioneering innovation and practices that support well-being for members. The Executive Physician Immersion Program is an internal program that accepts physicians each year. Every cohort will go through a two-year rotation where program participants:.

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. Search jobs. Latest Jobs.

Specialties Case Management. Published Jan 7, Can anyone offer insight about this position? Do you work from home, training, average salary, corporate culture? RN In FL. I worked in the capacity for Utilization Review and onsite review. Case loads were unmanageable, management was not supportive.

To try to control costs and reduce overuse or misuse of medical services like inpatient hospital stay, tests, surgeries, etc. To comply with this law, hospitals started employing nurses to review for the appropriateness of inpatient admissions and to determine if the number of days a patient remains in the hospital is appropriate and necessary; hence, utilization review was created. The goal of UR is to avoid burdening the healthcare system with unnecessary hospitalizations and procedures, all while ensuring that patients receive appropriate and evidence-based care. Private health insurance companies loved the concept of UR so much that they started implementing it on their end by hiring nurses to review prior authorization requests and claims, received from healthcare providers, for appropriateness. Some people use the acronyms UR and UM interchangeably, but there is a difference. UM is a program that a healthcare system has in place to ensure that patient care — from pre-admission to discharge — is medically necessary and cost-efficient. Think of UM as a big umbrella. UR is the actual process of reviewing services for medical necessity. To determine if a medical service is appropriate, the UR nurse reviews the clinical documentation then cross-references with evidence-based, nationally recognized guidelines.

Humana utilization review nurse

It's important to prepare for an interview in order to improve your chances of getting the job. Researching questions beforehand can help you give better answers during the interview. Most interviews will include questions about your personality, qualifications, experience and how well you would fit the job.

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Job Description. I prefer to go into an office, so I can leave work at work. View all events. Unfortunately, we cannot accept resumes that have been emailed to us. Other job opportunities utilization management i coordinator remote. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Ashley Care Management Telephonic Nurse 1. Building a culture of belonging We strive to create a culture where everyone feels welcome, supported, and empowered to being their authentic selves to work. Can I expect all UR companies to be like this or just Humana. Equal Opportunity Employer. Personal holidays. We have 52 Humana Neighborhood Centers across the U. Its hard not being in the office, having a cubie to look over at a co-worker for a quick question. The company is all about metrics.

So you want to become a utilization review UR nurse?

What was the compensation structure like. Nurses and Social Workers make a difference in assisting members in achieving lifelong well-being. Technical savvy and ability to navigate multiple systems and screens while working cases. Humana, Inc. Secret 13 Posts. Pharmacists will prepare for a career in managed care by building knowledge, skills and attitudes. 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. At Humana, we recognize diversity enhances our ability to understand and serve our members and communities. Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed. Apply online To be considered for a job, you must apply online.