DescriptionThe Telephonic Front End Review Nurse reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Telephonic Front End Review Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Telephonic Front End Review Nurse ensures mandatory reporting completed. Conducts and summarizes compliance audits. Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals. 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.
The ideal candidate for this position will live in the CO, AZ or NM area; have an active and unrestricted registered nursing license, BSN preferred; acute care experience, familiarity with MCG/Milliman/Interqual/CMS guidelines; background using Electronic Medical Record (EMR) systems; and strong computer acumen using MS Office products. This role will also require working 2 weekends per month.
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 Hours40