Employer Sponsored Job (Free to apply to)
Manager, Utilization Management Nursing - VA/NC/MD
The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
This role is based in the MidAtlantic region of VA, NC, MD, DC. The hours are Mon-Fri 8am-5pm est, with evening and weekend hours as needed.
There is a 4-6 week training plan, additional time may be needed/required depending on progress. Training is primarily virtual but 1-2 days in office and/or when new hires begin.
There is ongoing leadership trainings throughout the year—occasional travel may be required.
The Manager, Utilization Management Nursing 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. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
Licensed RN with no restrictions
Minimum 1 year UM experience specifically
Minimum of 2 years of management experience
Advanced computer skills, able to easily learn and navigate multiple applications
Go above and beyond when needed; flexible and can pivot in a fast pace environment
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
Health Plan experience
Managed care experience
As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.
If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.
Scheduled Weekly Hours
Equal Opportunity Employer
It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.
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 email@example.com for assistance.
Humana Safety and Security
Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact firstname.lastname@example.org to validate the request.
Last verified - 0 day(s) 23 hour(s) ago [What does Last Verified mean?]