Humana utilization review nurse

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!

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.

Humana utilization review nurse

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. Training was "learning the computer and the software, you would use to input your clinical documentation. NOT your actual job. It was sink or swim. Its hard not being in the office, having a cubie to look over at a co-worker for a quick question. If you are at home, everything is communicated via IM, and usually it takes the front line leader so long to respond, because she is busy in the office doing things there, and have stepped away from her desk.

Creating Healthy Communities is good for the Soul. Hiring Clinical 1 August 25, am - pm.

The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Success in this role requires the following:. Must be passionate about contributing to an organization focused on continuously improving consumer experiences. Solid analytical skills to understand and interpret data to make recommendations to improve patient care. Technical savvy and ability to navigate multiple systems and screens while working cases. An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed.

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. In this article, we review examples of various utilization review nurse interview questions and sample answers to some of the most common questions. The interviewer is trying to understand what drives the Utilization Review Nurse in their work. This question allows the interviewer to gauge whether the Utilization Review Nurse is passionate about their work and whether they are likely to be committed to the job. It also allows the interviewer to understand what motivates the Utilization Review Nurse and what they hope to achieve in their career. I want to help make sure that resources are used efficiently and effectively, and that patients have access to the care they need.

Humana utilization review nurse

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.

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I am not disciplined to work from home. 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. 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. Search for:. Search Jobs. Enrollment in any Humana plan depends on contract renewal. I would put in 12 hr days just to keep up. Can anyone offer insight about this position? To me its not worth the money, I believe other companies pay more. Onboarding If you accept the offer to join our Humana team, you will receive a welcome call or email to begin the onboarding process. The best part of this company is the commitment to associates, which naturally leads to commitment to members. Must be passionate about contributing to an organization focused on continuously improving consumer experiences. The Humana Pharmacy Solutions team offers careers to help transform health for all. Join our Talent Community to receive personalized updates about careers at Humana.

So you want to become a utilization review UR nurse?

Our Hiring Process. Our Louisville headquarters are home to 10 buildings and 4 fitness centers. 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. Hiring Clinical 1 August 25, am - pm. Justin Pharmacy Claims Representative. Our teams focus on the unique physical, social and emotional needs of seniors, with a whole-person approach to care. Collaboration skills to effectively interact with multiple parties both internal and external. Humana Pharmacy Solutions provides numerous clinical services to our patients and members that help improve their health and well-being. Humana has really helped my sense of belonging because I feel part of the team. We want to help you take charge of your path, no matter what shape it takes. Req : R Description Full-Time, Remote Telephonic opportunity As a Utilization Management RN working on the Home Solutions team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal at home. This is an exciting company headquartered in a city with an excellent quality of life!