Remote Utilization Management Nurse

Humana; United States; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical benefits

401(k) plan

Paid time off

Job summary

Humana is seeking a skilled Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care such as SNF, Home Health, and DME. You will report to the Manager of Utilization Management and collaborate with the One Home/Home Solutions UM team to ensure appropriate care in the right setting.

The role requires a compact RN license, 1+ year of clinical RN experience, and a passion for improving member experiences.

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as an RN in hospital, SNF, Home Health, or acute care setting.
• Passion for contributing to an organization focused on improving consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria based on information from attending physicians and other care providers.
• Complete request determinations within established processing time frames.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Help deliver coordinated care for our members.
• Understand department, segment, and organizational strategy and goals and linkages to related areas.

Skills

RN license

Clinical nursing experience

Communication with providers

Member experience improvement

Education

BSN or related degree

Tools

Milliman Care Guidelines

InterQual

Job description

Humana is seeking a skilled Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care such as SNF, Home Health, and DME. You will report to the Manager of Utilization Management and collaborate with the One Home/Home Solutions UM team to ensure appropriate care in the right setting.

The role requires a compact RN license, 1+ year of clinical RN experience, and a passion for improving member experiences.