Nurse jobs at Cigna

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Must have an active New York State clinical license; and a NYS Driver's License or Identification card. Position Purpose: The Utilization Review Nurse I provides first level clinical review for all outpatient and ancillary services requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a professional and competent manner. Processes all prior authorizations to completion utilizing appropriate review criteria. Identifies and refers all potential quality issues to the Clinical Quality Management Department, and suspected fraud and abuse cases to Program Integrity. Acts as liaison between the TRICARE beneficiary and the Network Provider. Provides first level RN review for all outpatient and ancillary prior authorization requests for medical appropriateness and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and determination. Completes data entry and correspondence as necessary for each review. Conducts rate negotiation with non-network providers, utilizing appropriate CMAC, DRG, HCPC reimbursement methodologies. Documents rate negotiation accurately for proper claims adjudication. Acts as liaison between the TRICARE beneficiary and the provider, facility and the MTF to utilize appropriate and cost effective medical resources within the direct care and purchased care system. Identifies and refers potential cases to Disease Management, Case Management, Demand Management and Transitional Care. Refers all potential quality issues and grievances to Clinical Quality Management and suspected fraud and abuse to Program Integrity. Performs other duties as assigned Complies with all policies and standards Education/Experience: Graduate of Nursing program; BSN desired or Graduate in Clinical Psychology or Clinical Social Work. Three years clinical experience in a health care environment; managed care experience desired. For Fidelis Care only: NYS RN, OT or PT license required Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **Applicants for this role have the flexibility to work remotely from their home anywhere in the Central time zone. This role will support Iowa Medicaid members and requires an Iowa or compact nursing license. The work schedule is Monday - Friday, 8am - 5 pm, with rotating weekend / holiday coverage.** Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines Reviews member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collaborates with care management on referral of members as appropriate Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines Reviews member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collaborates with care management on referral of members as appropriate Performs other duties as assigned Complies with all policies and standards We are seeking a Clinical Review Nurse - Concurrent Review to join our team! The ideal candidate will bring expertise in: Nurse with a IN or Compact State License Post Acute Care Experience Clinical Review Experience Problem Solving Skills Excellence Communicate Skills Computer Skills Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care Assists with service authorization requests for a member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collects, documents, and maintains all member's clinical information in health management systems to ensure compliance with regulatory guidelines Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members Provides feedback on opportunities to improve the authorization review process for members Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience. Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

**$10,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS** Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together** . In this position as a **Coding & Clinical Auditor / DRG Specialist RN** , you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims. Employing both industry and Optum proprietary tools, you will validate ICD-10 diagnosis and procedure codes, DRG assignments, and discharge statuses billed by hospitals to identify overpayments. Utilizing excellent communications skills, you will compose rationales supporting your audit findings. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification + Utilize expert knowledge to identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance + Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations and demonstrate working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments + Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing + Utilize solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment + Write clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics + Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly + Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements + Maintain and manage daily case review assignments, with a high emphasis on quality + Provide clinical support and expertise to the other investigative and analytical areas + Work in a high-volume production environment that is matrix driven **What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:** + Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Medical Plan options along with participation in a Health Spending Account or a Health Saving account + Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage + 401(k) Savings Plan, Employee Stock Purchase Plan + Education Reimbursement + Employee Discounts + Employee Assistance Program + Employee Referral Bonus Program + Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) + More information can be downloaded at: ************************* You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Associate's Degree (or higher) + Unrestricted RN (Registered Nurse) license + CCS/CIC or willing to obtain certification within 6 months of hire + 3+ years of MS DRG/APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies + 2+ years of ICD-10-CM coding experience including but not limited to: expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM) + 2+ years of ICD-10-PCS coding experience including but not limited to: expert knowledge of the structural components of PCS such as selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers **Preferred Qualifications:** + Experience with prior DRG concurrent and/or retrospective overpayment identification audits + Experience with readmission reviews of claims + Experience with DRG encoder tools (ex. 3M) + Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry + Healthcare claims experience + Managed care experience + Knowledge of health insurance business, industry terminology, and regulatory guidelines **Soft Skills:** + Ability to use a Windows PC with the ability to utilize multiple applications at the same time + Demonstrate excellent written and verbal communication skills, solid analytical skills, and attention to detail + Ability to work independently in a remote environment and deliver exceptional results + Excellent time management and work prioritization skills **Physical Requirements and Work Environment:** + Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer + Have a secluded office area in which to perform job duties during the work day + Have reliable high - speed internet access and a work environment free from distractions *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. The salary range for this role is $34.42 to $67.60 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. **_Application Deadline:_** _This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants._ _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._ \#RPO #GREEN #RPOLinkedin

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.** The Call Center Nurse RN is responsible for providing comprehensive clinical services to our customers located throughout the U.S. and may require multiple licenses to practice across various states. Services provided to our customers include but are not limited to the following telephonic services: clinical triage, transitions of care, medication adherence and reconciliation, management of gaps in care, and other care extension services. The Call Center Nurse assists and guides patients toward self-management and behavior modifications that result in improved patient outcomes. The Call Center Nurse is the primary point of contact for multiple disciplines. Success is measured in terms of improved patient outcomes, prevention of patient adverse events and satisfied customers, meeting or exceeding quality measures, producing consistent and high-quality work, and collaboration with other care team members. The Call Center Nurse is an experience nurse, able to perform tasks independently and once trained, without guidance. This person can provide education to patients, deploying best practices and standard workflow in their daily activities with the ability to apply their expertise across the various areas of responsibility, understanding how their interactions with patients affect customer satisfaction and can make recommendations to improve processes. Positions in this family require a current, unrestricted nursing license (RN) in the applicable state, as indicated in the function description and/or title. This is a PART TIME position working 7:30am - 6pm Eastern 2 days per week - either Mon and Friday OR Wednesday and Thursday. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Provide remote telephonic nursing support to patients, caregivers, and healthcare providers + Assess and triage patient calls to determine urgency of medical needs + Offer medical advice, guidance, and education to patients and caregivers regarding treatment plans, medication management, and self-care techniques + Collaborate with healthcare professionals to coordinate patient care and follow-up + Document patient interactions, assessments, and recommendations accurately and timely in electronic health records systems + Adhere to established protocols, guidelines, and best practices for telephonic nursing + Maintain patient confidentiality and privacy in accordance with HIPPA regulations + Participate in ongoing training and professional development activities to stay updated on medical advancements and best practices in telehealth + Contribute to quality improvement initiatives to enhance the delivery of telephonic nursing services + Provide exceptional customer service and support to ensure a positive experience for patients and clients + Ability to adapt nursing interventions and care plans to meet the individualized needs and preferences of diverse patients across the continuum of care + Demonstrates the ability to meet deadlines independently and efficiently, requiring minimal to no supervision + Actively engage in collaborative efforts within nursing team to ensure seamless communication, shared knowledge, and coordinated patient care delivery + Utilizes extensive expertise in chronic illnesses and medication management to effectively treat diseases + Works with supervisors to solve more complex problems You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Registered Nurse (RN) with a current, active, and unrestricted RN License in PA (state specific or compact) + 3+ years of clinical nursing experience + Experience with electronic medical records system(s) + Proven proficiency using MS Office Suite (i.e. Teams, Outlook, Word, Excel) + Ability to work PT hours (7:30am - 6PM EST) on either Monday and Friday OR Wednesday and Thursday **Preferred Qualifications:** + Telehealth nursing experience + Experience with Cerner *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. If you are located within Eastern Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST. Primary Responsibilities: * Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid * Identify if additional information is required to process an appeal * Ability to adapt to changes that require cross training on appeal types as they are identified * Ability to work independently * Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decision on administrative nurse level cases * Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Current, valid, and unrestricted RN licensure in your state of residence * 2+ years of clinical experience in an acute care or an outpatient setting * 1+ years of direct experience within one (or more) of the following areas: * Utilization Review * Medicaid and/or Medicare appeals experience * LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC * Proven experience/understanding of billable services and claims in a managed care environment * Solid Microsoft Office (Word, Excel & Outlook) Basic computer skills * Access to high-speed internet * Ability to work 8-5 within EST (Eastern standard time zone) Preferred Qualifications: * 5+ years of Medical Appeal experience working with Medicare and Medicaid * Solid coding experience or Certified Coder (CPC) * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims. Primary Responsibilities: * Review provider post-service appeals for Medicare and Retirement * Gather clinical information including medical records and coverage criteria as it pertains to Medicare guidelines * Discuss cases with medical directors when applicable * Ability to communicate and collaborate with other teams in order to gather medical information to process cases * Communicate effectively in both verbal and written documentation * Must meet quality and productivity metrics * Ability to work independently and prioritize * Attend mandatory trainings and scheduled staff meetings * Engage in respectful and courteous team dialog via email, IM and in staff meeting You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Undergraduate degree or equivalent experience * Unrestricted, active RN license * 2+ years of RN experience in acute setting * Proven working knowledge of Clinical Criteria and CMS Guidelines/InterQual * Proven proficiency in basic computer skills * Demonstrated ability to have high speed internet installed in home for Secure Job use only * Proven designated HIPPA compliant home workspace Preferred Qualifications: * Undergraduate degree (BSN) * Proven utilization management, prior authorization, case management or prior appeals experience * Proven claims and coding experience Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Become a part of our caring community and help us put health first Humana Healthy Horizons in Indiana is seeking a Care Coordinator 2 (Field Care Manager 2) who assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. This position serves members of the new Indiana Medicaid program - Indiana PathWays for Aging (PathWays). The program was designed to help more Hoosiers who choose to age at home, do so, and to achieve better access to services, and better health and quality outcomes. You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We are proud of our Louisville roots and, as we have grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are-whether you are working from home, from the field, from our offices, or from somewhere in between-you will feel welcome here. We are a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone's voice is heard and respected. Community is a verb here. It is up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve. * Health Insurance begins on day one! * 23 days of vacation with pay per year * Aggressive 401K program matching 125% of 6% after year one! Are you caring, Curious and Committed? If so, apply today! Position Responsibilities: The Care Coordinator 2 employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Facilitate the development of a longitudinal and trusting relationship with each member toward improved quality, continuity, and coordination of care. Responsible for the coordination of all the member's needed medical and non-medical services, including functional, social, and environmental services. Works collaboratively with the Service Coordinator, Transition Coordinator, and other care team staff to address the member's identified needs Coordinates with all Medicare payers, Medicare Advantage plans, and Medicare providers as appropriate to coordinate the care and benefits of members who are also eligible for Medicare. Primary point of contact for the Interdisciplinary Care Team (ICT) and shall be responsible for coordinating with the member, ICT participants, and outside resources to ensure the member's needs are met. Use your skills to make an impact Required Qualifications Licensed Registered Nurse (RN) in the state of Indiana without restrictions At least one (2) years of clinical experience as a nurse in providing case management or similar health care services (internal note: could be LPN experience if relevant) Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook. Exceptional communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders. Proven ability of critical thinking, organization, written and verbal communication and problem- solving skills. Ability to manage multiple or competing priorities in a fast-paced environment. Ability to use a variety of electronic information applications/software programs including electronic medical records. Live/Reside in Indiana Preferred Qualifications Bilingual (English/Spanish) or (English/Burmese) Prior nursing home diversion, long-term care, disease management, or case management experience Prior management of Home and Community Based Services waivers (HCBS dual roles only) Prior experience with Medicare & Medicaid recipients Experience working with a geriatric population Experience with health promotion, coaching and wellness Knowledge of community health and social service agencies and additional community resources Additional Information About Humana Your growth is what drives Humana forward. When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we do not grow without you This is a place where our nurses influence the C-suite. Where software engineers change lives. Where every associate can build a professional path where they learn and thrive. Through our commitments to wellbeing and work-life balance, we support each associate's personal health, purpose, work style, sense of belonging, and security. Because finding new ways to put health first-for our members and patients and our associates alike-is what we do. Additional Requirements/Adherence Workstyle: Combination remote work at home and onsite member visits Location: Must reside in Indiana Hours: Must be able to work a 40-hour work week, Monday through Friday 8:00 AM to 5:00 PM, over-time may be requested to meet business needs. Travel: Must be willing to commute about 70% to meet with members. On Call-Telephonic on call for an occasional night and/or weekend may be required. Work at Home Guidance To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Driver's License, Transportation, Insurance This role is a part of Humana's Driver Safety program and therefore requires and individual to have: Valid state driver's license Proof of personal vehicle liability insurance with at least $100,000/$300,000/$100,000 limits Access to a reliable vehicle Tuberculosis (TB) screening program This role is considered patient facing and is part of Humana at Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Interview Format As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. You will be able to respond to the recruiters preferred response method via text, video, or voice technologies. If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication is not missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** This is a Field Based role with a Home-Based office. Must be open to traveling up to 50 miles from home office based on business need. If you are located in or within commutable driving distance from South Austin, TX, you will have the flexibility to telecommute* as you take on some tough challenges. **Primary Responsibilities:** + Assess, plan and implement care strategies that are individualized by patients and directed toward the most appropriate, at least restrictive level of care + Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services + Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members + Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include: + Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Medical Plan options along with participation in a Health Spending Account or a Health Saving account + Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage + 401(k) Savings Plan, Employee Stock Purchase Plan + Education Reimbursement + Employee Discounts + Employee Assistance Program + Employee Referral Bonus Program + Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) + More information can be downloaded at: ************************* You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Current and unrestricted Registered Nurse license in the state of Texas + 2+ years of experience working within the community health setting or in a healthcare role + Intermediate level of computer proficiency (including Microsoft Outlook, Teams) and ability to use multiple web applications + Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service + Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) + Valid driver's license, access to reliable transportation and the ability to travel in this 'assigned region' to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers' offices + Reside in or within commutable driving distance from South Austin, TX **Preferred Qualifications:** + 1+ years of experience with long-term care services and support, Medicaid or Medicare + Knowledge of the principles of most integrated settings, including federal and State requirements like the federal home and community-based settings regulations + Proven ability to create, edit, save and send documents, spreadsheets and emails + Reside in South Austin, TX *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together This is a Field Based role with a Home-Based office. Must be open to traveling up to 50 miles from home office based on business need. If you are located in or within commutable driving distance from South Austin, TX, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: * Assess, plan and implement care strategies that are individualized by patients and directed toward the most appropriate, at least restrictive level of care * Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services * Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members * Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include: * Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays * Medical Plan options along with participation in a Health Spending Account or a Health Saving account * Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage * 401(k) Savings Plan, Employee Stock Purchase Plan * Education Reimbursement * Employee Discounts * Employee Assistance Program * Employee Referral Bonus Program * Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) * More information can be downloaded at: ************************* You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Current and unrestricted Registered Nurse license in the state of Texas * 2+ years of experience working within the community health setting or in a healthcare role * Intermediate level of computer proficiency (including Microsoft Outlook, Teams) and ability to use multiple web applications * Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service * Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) * Valid driver's license, access to reliable transportation and the ability to travel in this 'assigned region' to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers' offices * Reside in or within commutable driving distance from South Austin, TX Preferred Qualifications: * 1+ years of experience with long-term care services and support, Medicaid or Medicare * Knowledge of the principles of most integrated settings, including federal and State requirements like the federal home and community-based settings regulations * Proven ability to create, edit, save and send documents, spreadsheets and emails * Reside in South Austin, TX * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Become a part of our caring community and help us put health first The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical documentation to ensure capture of all relevant coding. Applies clinical and coding experience to conduct a clinical validation review of the inpatient medical record to validate billed diagnoses. 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. Use your skills to make an impact WORK STYLE: Remote/Work at Home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Associates are expected to start each day between 6AM and 9AM in their home time zone. Required Qualifications Active Registered Nurse (RN) license in the state they reside. Minimum of 2 consecutive years acute inpatient hospital care experience in critical, intensive care setting within the last 5 years (Not pediatrics or neonatal). For example: ICU, CCU, PCU, med-surg/adult units or a minimum of 2 years DRG Inpatient auditing. NOTE: Inpatient experience does not refer to any other levels of care such as ER, OR, Pre-op, PACU, L&D, mother-baby, behavioral health, SNF, care manager/discharge manager, LTC, rehab, outpatient or office/clinic visits such as wound care, oncology, radiology, interventional radiology, lab, hospice, or home health. In depth knowledge and critical understanding of complex medical diagnoses including, but not limited to, Sepsis (including end-organ failure), Pneumonia, Acidosis, Renal Failure, Encephalopathy, CVA, DKA, MI, etc. Advanced knowledge of MS Office (Word, Excel, etc) Excellent writing, editing, interpersonal, planning, teamwork, and communications skills Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information Ability to work independently and manage workload Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession Preferred Qualifications Bachelor's Degree in relevant field preferred Inpatient coding certification (AHIMA or AAPC - ex: RHIA, RHIT, CCS, CIS, CIC) Inpatient coding claim experience Prospective payment methodologies, DRG auditing experience Clinical documentation improvement knowledge (CDE, CDEI certification) Additional Information Work at Home Requirements • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested • Satellite, cellular and microwave connection can be used only if approved by leadership • Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $78,400 - $107,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.** There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. **Schedule will be Monday through Friday from 8AM-5PM. Role does not require nights or Holidays however occasional weekend work may be required based off business needs.** You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria) + Discuss cases with facility healthcare professionals to obtain plans-of-care + Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management + Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level + Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners + Apply clinical expertise when discussing case with internal and external Case Managers and Physicians + Identify delays in care or services and manage with MD + Follow all Standard Operating Procedures in end to end management of cases + Obtain clinical information to assess and expedite alternate levels of care + Facilitate timely and appropriate care and effective discharge planning + Participate in team meetings, education, discussions, and related activities + Maintain compliance with Federal, State and accreditation organizations + Identify opportunities for improved communication or processes + Participate in audit activities and meetings You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Active, unrestricted RN license in state of residence + 3+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF/AIR/ LTAC, Emergency Department, Urgent Care) + Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities + Demonstrated proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms + Designated workspace and access to install secure high-speed internet via cable / DSL in home **Preferred Qualifications:** + Bachelor's degree + Compact RN license + 2+ years case management experience + 1+ years Background that involves utilization review and evidence-based guidelines (InterQual Guidelines) + Managed care experience + Experience performing discharge planning *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy **California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only:** The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

**Become a part of our caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical documentation to ensure capture of all relevant coding. Applies clinical and coding experience to conduct a clinical validation review of the inpatient medical record to validate billed diagnoses. 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. **Use your skills to make an impact** **WORK STYLE:** Remote/Work at Home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Associates are expected to start each day between 6AM and 9AM in their home time zone. **Required Qualifications** + Active Registered Nurse (RN) license in the state they reside. + Minimum of 2 consecutive years acute inpatient hospital care experience in critical, intensive care setting within the last 5 years (Not pediatrics or neonatal). For example: ICU, CCU, PCU, med-surg/adult units or a minimum of 2 years DRG Inpatient auditing. NOTE: Inpatient experience does **not** refer to any other levels of care such as ER, OR, Pre-op, PACU,L&D, mother-baby, behavioral health, SNF, care manager/discharge manager, LTC, rehab, outpatient or office/clinic visits such as wound care, oncology, radiology, interventional radiology, lab, hospice, or home health. + In depth knowledge and critical understanding of complex medical diagnoses including, but not limited to, Sepsis (including end-organ failure), Pneumonia, Acidosis, Renal Failure, Encephalopathy, CVA, DKA, MI, etc. + Advanced knowledge of MS Office (Word, Excel, etc) + Excellent writing, editing, interpersonal, planning, teamwork, and communications skills + Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information + Ability to work independently and manage workload + Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession **Preferred Qualifications** + Bachelor's Degree in relevant field preferred + Inpatient coding certification (AHIMA or AAPC - ex: RHIA, RHIT, CCS, CIS, CIC) + Inpatient coding claim experience + Prospective payment methodologies, DRG auditing experience + Clinical documentation improvement knowledge (CDE, CDEI certification) **Additional Information** **Work at Home Requirements** - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested - Satellite, cellular and microwave connection can be used only if approved by leadership - Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $78,400 - $107,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities. **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

**Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues. Coordinates the clinical resolution with internal/external clinician support as required. Documents and summarizes to all parties involved in the case the investigation's results. 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. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may be needed including timeframes when physician is available for peer to peer review, and forward to physician review companies or TQMC. Monitor and follow up for timeliness and review response and determination to insure follows TRICARE policy requirements. If discrepancies found will send back for follow up review and correction as needed. + Review, coordinate, arrange and maintain Second level Review /Reconsideration records and patient and provider response letters + Provide education to beneficiaries and providers regarding second level review time frames, process and review determinations. If needed provide education on alternatives for services that may be not be approved + Maintain knowledge of TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements **Use your skills to make an impact** **Required Qualifications** + Our Department of Defense contract requires U.S. Citizenship + Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing) + HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico. + Active unrestricted RN license + 3 years of clinical RN Experience + Appeals nursing experience + Claims experience + Proficient with Microsoft Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG guidelines + Working knowledge of ICD-9 or ICD-10, HCPCS, DRG use + Experience with TRICARE contracts and/or the military health care delivery system + Knowledge of TRICARE policies and programs + Bachelor's degree **Additional Information** **Work Style** : Remote **Work Days/Hours:** Monday - Friday; 8:00 a.m.-5 p.m. Eastern Standard Time **Work at Home Requirements** To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities. **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 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. Use your skills to make an impact Use your skills to make an impact Required Qualifications Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action. MUST have Compact License Greater than one year of clinical experience in a RN role in acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc. Comprehensive knowledge of Microsoft Word, Outlook and Excel Ability to work independently under general instructions and with a team Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Education: BSN or Bachelor's degree in a related field Three or more years of clinical experience in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc. Experience as an MDS Coordinator or discharge planner in an acute care setting Previous experience in utilization management/utilization review for a health plan or acute care setting Compact license PLUS a single state RN Licensure in any of the following non-compact states: California, Hawaii, Nevada, Oregon Health Plan experience Previous Medicare/Medicaid Experience a plus Call center or triage experience Bilingual is a plus Additional Information Scheduled Weekly Hours: 40 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Work-At-Home Requirements 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 is 25mbs download x 10mbs upload is required. Check your internet speed at ***************** A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities. About us About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. OneHome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Become a part of our caring community and help us put health first This is a Work-At-Home position located in Puerto Rico. You must live in Puerto Rico for this position. The RN Care Manager works in a telephonic environment. They assess and evaluate members' needs and requirements to achieve and maintain an optimal wellness state. Using clinical knowledge, the Care Manager guides members with chronic conditions toward and facilitates interaction with resources appropriate for their care and wellbeing. The Care Manager, Telephonic Nurse's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. You must be fully bilingual in English/Spanish and will be required to pass a test for both languages - Speaking/Reading/Writing included. ***Please submit resume in English. The Care Manager, Telephonic Nurse employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Responsibilities include the following: Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. 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. Use your skills to make an impact Required Qualifications Bachelor's Degree in Nursing (BSN) Bilingual in English and Spanish (and able to pass language proficiency tests in both languages) Active RN license without restrictions in Puerto Rico Active RN license without restrictions in Florida - if you DO NOT have an active FL RN license, you must have already passed the NCLEX exam. Affiliated with the CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico). Prior clinical experience in adult acute care, skilled nursing, rehabilitation or discharge planning Knowledge in Chronic Condition management (treatment, pharmacological treatment, signs & symptoms, etc.) Diabetes, Hypertension, COPD, Chronic Kidney Disease, etc. Ability to work independently under minimum supervision and with a team. Able to work an 8-hour shift between 8:30 AM - 5:30 PM EST and adjusted for Daylight Savings (Work schedule can be adjusted according to business hours - necessary overtime and/or weekends) Preferred Qualifications Health Plan experience Previous Case Management Experience Call center or triage experience Previous experience managing Medicare members Work-At-Home Requirements To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Humana will provide Work-At-Home employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Language Proficiency Testing Any Humana associate who speaks with a member in a language other than Spanish must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Additional Information As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $53,300 - $73,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities. About Us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

**$5000 Sign On Bonus for External Candidates** Explore opportunities with Caretenders, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of **Caring. Connecting. Growing together.** As the Clinical Director, you will oversee and direct the patient care operations of the home care facility. This includes: coordinating and completing assigned projects to effectively support the immediate and long range objectives of the company; oversight of the eligibility of patients referred to home care services, planning for the services to be provided to patients and supervising their total home health care; implementing and maintaining administrative practices, agency philosophy, goals, and policies which assure compliance with applicable state and federal regulations; enhancing the profitability of the agency; and providing motivation and retention of a qualified staff and assure the quality of services delivered. This position also acts as a liaison with management staff and other departments throughout the company. **Primary Responsibilities:** + Coordinates and completes assigned projects to effectively support the immediate and long-range objectives of the company + Oversees the eligibility of patients referred to home care services, planning for the services to be provided to patients and supervising their total home health care + Implements and maintains administrative practices, agency philosophy, goals, and policies which assure compliance with applicable state and federal regulations. + Enhances the profitability of the agency; and providing motivation and retention of a qualified staff and assure the quality of services delivered + All CMS and state regulations must be followed regarding supervision of nursing services + If Clinical Director is not an RN, Executive Director/Administrator or Patient Care Manager must be designated as supervising RN for nursing services unless state regulations dictate otherwise You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Current and unrestricted RN licensure in the state of practice or PT/OT/SLP, must have current applicable license in the state + Current CPR certification + Current Driver's License and vehicle insurance, and access to a dependable vehicle, or public transportation **Preferred Qualifications:** + 1+ years of supervisory and/or management experience in home health setting or related healthcare setting + Ability to manage multiple tasks simultaneously + Able to work independently + Good communication, writing, and organizational skills Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

$5000 Sign On Bonus for External Candidates Explore opportunities with Caretenders, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As the Clinical Director, you will oversee and direct the patient care operations of the home care facility. This includes: coordinating and completing assigned projects to effectively support the immediate and long range objectives of the company; oversight of the eligibility of patients referred to home care services, planning for the services to be provided to patients and supervising their total home health care; implementing and maintaining administrative practices, agency philosophy, goals, and policies which assure compliance with applicable state and federal regulations; enhancing the profitability of the agency; and providing motivation and retention of a qualified staff and assure the quality of services delivered. This position also acts as a liaison with management staff and other departments throughout the company. Primary Responsibilities: * Coordinates and completes assigned projects to effectively support the immediate and long-range objectives of the company * Oversees the eligibility of patients referred to home care services, planning for the services to be provided to patients and supervising their total home health care * Implements and maintains administrative practices, agency philosophy, goals, and policies which assure compliance with applicable state and federal regulations. * Enhances the profitability of the agency; and providing motivation and retention of a qualified staff and assure the quality of services delivered * All CMS and state regulations must be followed regarding supervision of nursing services * If Clinical Director is not an RN, Executive Director/Administrator or Patient Care Manager must be designated as supervising RN for nursing services unless state regulations dictate otherwise You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Current and unrestricted RN licensure in the state of practice or PT/OT/SLP, must have current applicable license in the state * Current CPR certification * Current Driver's License and vehicle insurance, and access to a dependable vehicle, or public transportation Preferred Qualifications: * 1+ years of supervisory and/or management experience in home health setting or related healthcare setting * Ability to manage multiple tasks simultaneously * Able to work independently * Good communication, writing, and organizational skills Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.