Onsite Acute Utilization Management Nurse, WVU/Ruby Memorial Hospital

Company: Humana
Location: Not Specified, West Virginia, United States
Type: Full-time
Posted: 08.NOV.2018


Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communicatio...



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.


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

+ Active RN license in the state(s) in which the nurse is required to practice

+ Prior clinical experience in an acute care setting

+ Ability to work independently under general instructions and with a team

+ Ability to research and problem solve independently

+ Strong listening and communication skills

+ Positive attitude and ability to adapt to change quickly

+ Proficient with Microsoft Office including Word, Excel and Outlook and Excel

+ Valid driver?s license and/or dependable transportation necessary (variable by region)

+ This role is considered patient facing and is part of Humana?s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB

Preferred Qualifications

+ Education: BSN or Bachelor?s degree in a related field

+ Previous Medicare Experience

+ Health Plan experience

+ Previous experience in utilization review

Additional Information

+ Work location: This role requires being onsite daily at the facility ? WVU/Ruby Memorial Hospital

+ Hours are: Monday-Friday 8:00am-5:00pm

Scheduled Weekly Hours


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