Remote Utilization Management Nurse - Care Coordination

Humana Inc; Topeka (KS); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.

This role involves working with the One Home/Home Solutions Utilization Management team to manage post-acute care services across SNF, Home Health, and DME. The position requires an active compact RN license, 1+ year of clinical RN experience, and a passion for improving consumer experiences.

Qualifications

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

Responsibilities

• Interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Make determinations using established medical criteria based on information from physicians and 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 operating goals and their linkages to related areas.

Skills

RN license

Clinical nursing experience

Communication with providers

Education

BSN or bachelor's degree

Job description

Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.

This role involves working with the One Home/Home Solutions Utilization Management team to manage post-acute care services across SNF, Home Health, and DME. The position requires an active compact RN license, 1+ year of clinical RN experience, and a passion for improving consumer experiences.