Experienced Remote Registered Nursing Clinical Reviewer – Utilization Management and Quality Improvement Specialist

Introduction to Humana and Our Mission Humana, a leading healthcare company, is dedicated to delivering innovative care and well-being solutions that improve the lives of our members. We are passionate about providing high-quality, patient-centered care that is accessible, affordable, and effective. Our remote roles are designed to offer flexibility and work-life balance while maintaining the highest standards of care. If you are a registered nurse seeking a fulfilling career opportunity that allows you to make a meaningful impact from the comfort of your home, we encourage you to explore our Remote Registered Nursing Clinical Reviewer PRN position. Job Overview and Responsibilities As a Remote Registered Nursing Clinical Reviewer PRN, you will play a critical role in our utilization management and quality improvement efforts. Your primary responsibility will be to review clinical information submitted by healthcare providers, assessing the appropriateness of treatment plans and ensuring they meet established guidelines. You will also identify any missing or incomplete information and follow up with providers as needed. Additionally, you will communicate any concerns or discrepancies found during your review process with healthcare providers, providing clear and concise feedback in a professional manner. Reviewing clinical information submitted by healthcare providers to assess the appropriateness of treatment plans Identifying missing or incomplete information and following up with providers as needed Communicating concerns or discrepancies found during the review process with healthcare providers Providing recommendations to healthcare providers to improve patient outcomes and ensure efficient use of resources Documenting findings and recommendations in a clear and concise manner Collaborating with other departments, such as IT, marketing, and compliance, to ensure the accuracy and consistency of content Staying up-to-date with industry standards and best practices to ensure the highest quality of content Requirements and Qualifications To be successful in this role, you must possess an active registered nursing license in the state where you reside, with a minimum of two years of clinical experience in a hospital, acute care, or direct patient care setting. You should also have experience in clinical review or a similar field, with a strong understanding of medical terminology and critical thinking skills. Additionally, you must be compassionate, detail-oriented, and possess strong communication skills, both written and verbal. Active registered nursing license in the state of residence Minimum of two years of clinical experience in a hospital, acute care, or direct patient care setting Experience in clinical review or a similar field Strong understanding of medical terminology and critical thinking skills Compassionate and detail-oriented approach to patient care Strong communication skills, both written and verbal Proficiency in electronic health record systems (EHRs) Preferred Qualifications and Skills While not required, we prefer candidates with experience working in a remote or virtual environment, with a strong understanding of utilization management and quality improvement principles. You should also be proficient in Microsoft Office, with excellent analytical and problem-solving skills. Additionally, experience with data analysis and reporting tools, such as Excel or Tableau, is highly desirable. Experience working in a remote or virtual environment Strong understanding of utilization management and quality improvement principles Proficiency in Microsoft Office, with excellent analytical and problem-solving skills Experience with data analysis and reporting tools, such as Excel or Tableau Strong organizational and time management skills, with the ability to prioritize tasks and meet deadlines Career Growth Opportunities and Learning Benefits At Humana, we are committed to supporting the professional growth and development of our employees. As a Remote Registered Nursing Clinical Reviewer PRN, you will have access to comprehensive training and ongoing education, including training on our EHR system, clinical review guidelines, and company policies. You will also have opportunities to collaborate with other departments, such as IT, marketing, and compliance, to ensure the accuracy and consistency of content. Additionally, you will be part of a team dedicated to improving patient outcomes and delivering exceptional care, with opportunities for career advancement and professional growth. Work Environment and Company Culture Our remote work environment is designed to offer flexibility and work-life balance, with a focus on supporting the mental and physical health of our employees. We prioritize work-life balance by offering flexible work schedules, wellness programs, and resources to support your mental and physical health. Our company culture is built on a foundation of integrity, compassion, and excellence, with a commitment to delivering high-quality, patient-centered care. We value diversity, equity, and inclusion, and are dedicated to creating a workplace that is welcoming and inclusive to all employees. Compensation, Perks, and Benefits We offer a competitive salary, with a range of $2,900 to $3,500 per month, depending on experience. You will also be eligible for a range of benefits, including medical, dental, and vision insurance, as well as a 401(k) retirement savings plan. Additionally, you will have access to a range of perks, including flexible work schedules, wellness programs, and resources to support your mental and physical health. Conclusion and Call to Action If you are a registered nurse seeking a fulfilling career opportunity that allows you to make a meaningful impact from the comfort of your home, we encourage you to apply for our Remote Registered Nursing Clinical Reviewer PRN position. With comprehensive training, career advancement opportunities, and a supportive work environment, you will find professional fulfillment and personal growth in this role. Don't hesitate to apply today and join our team of dedicated healthcare professionals who are passionate about delivering high-quality, patient-centered care. We want to hear from you! If this role sounds like a perfect fit, don't hesitate to apply. We look forward to receiving your application and exploring how you can contribute to our team. Apply for this job