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, humana utilization review nurse, assessment, review or leadership capacities.

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. The compensation range below reflects a good faith estimate of starting base pay for full time 40 hours per week employment at the time of posting.

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.

We want to help you take charge of your path, no matter what shape it takes. Good luck.

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.

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. 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.

Jabra move style edition amazon

Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed. I worked at Aetna and still be there if I would not had to take an LOA due to a medical illness in Usually high pressure jobs offer some form incentive to put up with the pressure. Home Health. 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. Majenta Inbound Contact Representative. Examples of those programs include:. And comparison's to other regions. I haven't started yet. Rosemary Senior Consumer Experience Professional. Search jobs. Best thing I could have done to regain my sanity was to resign, and not look back, and regain my confidence.

So you want to become a utilization review UR nurse?

Clinical Support. Rosemary Senior Consumer Experience Professional. Next Step If selected to continue with the interview process, you will be contacted through text or email to complete an assessment or schedule an initial live or recorded phone or video interview. They measured your performance by metrics, how long it took you to close out a case. Be sure to update your resume and upload it as you cannot edit the resume or add it after the application has been submitted. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. I prefer to go into an office, so I can leave work at work. Tuition assistance. The position sounds intense. View all events. Usually high pressure jobs offer some form incentive to put up with the pressure. Training was "learning the computer and the software, you would use to input your clinical documentation. Good Luck. I haven't started yet. Justin Pharmacy Claims Representative.