Humana Onsite Nurse Reviewer (RN) - Phoenix, AZ (Gilbert/Chandler) in Phoenix, Arizona


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.

Required Qualifications

  • 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

Preferred Qualifications

  • 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

Additional Information

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


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