LTSS UM Nurse Manager
Humana
full-time
Posted on:
Location Type: Remote
Location: Missouri • Ohio • United States
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Salary
💰 $94,900 - $130,500 per year
About the role
- Report to the Associate Director of Care Management
- Use clinical nursing skills to support coordination, documentation, and communication of medical services and benefit administration determinations
- Operate within established guidelines and use advanced technical expertise to address moderately complex issues
- Determine methods, resources, schedules, and goals based on assigned goals
- Responsible for leadership and oversight of the physical health Utilization Management staff in daily operations
- Hire, coach, counsel and evaluate performance of direct reports
- Implement and maintain processes compliant with MDHHS and NCQA guidelines
- Work with UM leadership to reduce inefficiencies and provide solutions to improve clinical outcomes
- Collect and analyze data to guide operational metrics and associate performance
- Coordinate and communicate with Providers, Members, or other parties to facilitate care and treatment
- Facilitate cross-departmental collaboration and conduct briefings and area meetings; maintain frequent contact with other managers across departments.
Requirements
- Bachelor's Degree
- 2 or more years of management experience
- Licensed Registered Nurse (RN) in Michigan with no disciplinary action
- Previous experience in utilization management
- 1+ years experience within long-term services and supports (LTSS) programs, including knowledge of Medicaid waivers, care coordination, and eligibility requirements
- Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Demonstrated ability to work independently under general instructions and collaboratively within interdisciplinary care teams, including social workers, nurses, and allied health professionals.
Benefits
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical nursing skillsutilization managementdata analysiscare coordinationperformance evaluationprocess implementationgoal settingresource managementdocumentationbenefit administration
Soft Skills
leadershipcoachingcounselingcommunicationcollaborationindependent workinterdisciplinary teamworkproblem-solvingorganizational skillsperformance management
Certifications
Bachelor's DegreeLicensed Registered Nurse (RN) in Michigan