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Become a part of our caring community and help us put health firstHumana Healthy Horizons in Virginia is seeking a Manager, Utilization Management Nursing who will use their 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.
Uses clinical knowledge, communication skills, and independent critical thinking skills toward interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.
Provides leadership and oversight of the physical health Utilization Management (UM) staff in daily operations.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Implements and maintains processes that are compliant with the Virginia Department of Medical Assistance Services (DMAS) and National Committee for Quality Assurance (NCQA) guidelines.
Works collaboratively with UM leadership to assess and mitigate inefficiencies and provide solutions to improve clinical outcomes.
Collects and analyzes data as necessary to drive operational metrics and associate performance.
Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
Makes decisions that are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
Facilitates cross departmental collaboration and conduct briefings and area meetings; maintains frequent contact with other managers across functional areas.
Use your skills to make an impactRequired Qualifications
Licensed Registered Nurse (RN) in the commonwealth of Virginia, with no disciplinary action.
Minimum two (2) years of leadership experience.
Minimum two (2) years of experience in utilization management.
Prior clinical experience preferably in skilled acute care settings.
Ability to work independently under general instructions and with a team.
Preferred Qualifications
BSN or bachelor's degree in health services, healthcare administration, or business administration.
Additional Information
Workstyle & Travel: This position is remote and requires travel to our Humana Healthy Horizons location in Glen Allen, VA for collaboration and face to face meetings.
Typical Workdays & Hours: Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST).
Weekend On-Call Rotation: This position will require you to be on-call occasionally on weekends.
Work at Home Internet StatementTo ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview FormatAs part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.Scheduled Weekly Hours40Pay RangeThe 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. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$84,600 - $116,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision 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 usHumana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. 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 complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.