The Onsite Nurse Reviewer utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Onsite Nurse Reviewer work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Onsite Nurse Reviewer 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.
This is an onsite position in which you will spend approximately 50% of your time working from home and 50% of your time working onsite at various medical facilities. These percentages are subject to change. The primary locations for the onsite portion of the position are in: Chandler, Gilbert and the downtown Phoenix area.
Must live within a commutable distance of either Chandler, Gilbert or downtown Phoenix, AZ
Active Registered Nursing license free of restrictions for the state of AZ
At least 3 years of varied clinical nursing experience required - preferably in an acute care, skilled or rehabilitation clinical setting
At least 2 years of bedside care
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and with a team
Valid driver's license
Must have the ability to provide 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 optimal performance of 10x1 (10mbs download x 1mbs upload) is required
Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.
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.
Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10 panel drug test
Bachelor's in Nursing preferred
Experience working in utilization management
Experience using MCG/Milliman or Interqual guidelines
Background working in post acute, SNF, LTAC or discharge planning
Health Plan experience
Previous Medicare/Medicaid experience a plus
Bilingual is a plus
The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective April 1, 2011, Humana has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.
Scheduled Weekly Hours
Equal Opportunity Employer
It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.
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