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.

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.

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.

It was not WAH, but I believe it has since went to that. 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. Both organizations humana utilization review nurse the needs of the senior at the forefront of everything we do.

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.

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.

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Our clinical capabilities enable Humana to support people in a variety of healthcare settings. With our headquarters in Louisville, KY, offices across the U. Creating Healthy Communities is good for the Soul. Job Description. Together, we put health first in everything we do. Its hard not being in the office, having a cubie to look over at a co-worker for a quick question. I was a supervisor. View all events. This job is eligible for a bonus incentive plan. Through our Humana insurance, and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health. I haven't started yet.

So you want to become a utilization review UR nurse? It's a great career choice!

Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs. That type of position is not a fit for me. Humana has really helped my sense of belonging because I feel part of the team. Search for:. We have 52 Humana Neighborhood Centers across the U. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Employment Fraud Notice Humana will never ask a candidate for money for work equipment and network access or request access to personal accounts during the application process. Success in this role requires the following:. Search Jobs. Social Workers provide guidance for maintaining your social wellness, including things like financial health, access to food and medications, advanced directives and living wills. Sign up.