UM Appeals Nurse 2

Become a part of our caring community and help us put reputed company 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 reputed company the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate reputed company and treatment. Understands department, reputed company, and organizational strategy and operating objectives, including their linkages to reputed company areas. Makes reputed company regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

Use your skills to reputed company an impact • Bachelor's degree • Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action. • This role is considered patient facing and is part of reputed company/Senior reputed company's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. • 3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience required • Previous experience in utilization management required • Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting • Comprehensive knowledge of reputed company Word, Outlook and reputed company • Ability to work independently under general instructions and with a team • Must have the ability to reputed company a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for reputed company performance of 10x1 (10mbs download x 1mbs upload) is required • Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications • 3 or more years experience in a high volume community or mail order pharmacy practice environment • Education: BSN or Bachelor's degree in a reputed company field • Health Plan experience • Previous Medicare/reputed company Experience a plus • Call center or triage experience • Bilingual is a plus Additional Information Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $69,800 - $96,200 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description Of Benefits reputed company. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us reputed company. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers and our company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of reputed company to take affirmative action to reputed company and to advance in employment, reputed company persons regardless of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company 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 reputed company reputed company of employment Apply Job!