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. Our teams focus on the unique physical, social and emotional needs of seniors, with a whole-person approach to care.

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. And you are needing help. Too many conference calls. Not sure is you will be working from home or not, or which office.

Onboarding If you accept the offer to join our Humana team, you will receive a welcome call or email to begin the onboarding process. Justin Pharmacy Claims Representative. Thank you for the update.

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.

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.

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. 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.

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Specialties Case Management. Can I expect all UR companies to be like this or just Humana. In this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment. Success in this role requires the following: Must be passionate about contributing to an organization focused on continuously improving consumer experiences. They measured your performance by metrics, how long it took you to close out a case. Usually high pressure jobs offer some form incentive to put up with the pressure. 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. Humana will never ask a candidate for money for work equipment and network access or request access to personal accounts during the application process. Shift is Monday - Friday am - pm Eastern Standard Time Rotational Evening, Weekends and Holiday coverage required between 8 AM to 8 PM EST Responsibilities -- A secure home-office space, full-time uninterrupted work hours and hard-wired, high-speed internet service is required for this position -- The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Latest Nursing Jobs. The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. I tend to always want to turn the computer back on to "catch up", and that is not good.

So you want to become a utilization review UR nurse? It's a great career choice! UR nurses are in demand, and the job outlook is good.

Usually high pressure jobs offer some form incentive to put up with the pressure. Equal Opportunity Employer. Can I expect all UR companies to be like this or just Humana. Generous K match, financial planning services and a bonus structure that includes an Associate Incentive Plan. By using the site, you agree with our Policies. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. I would put in 12 hr days just to keep up. Home Health. The best part of this company is the commitment to associates, which naturally leads to commitment to members. This job is eligible for a bonus incentive plan. Nurses and Social Workers make a difference in assisting members in achieving lifelong well-being.