Remote Utilization Management Nurse - Care Coordination

Humana; Town of Texas (WI); On-site; USD 71,000 - 98,000; Full time

Job summary

Humana in Wisconsin is seeking an Utilization Management Registered Nurse to interpret and support medical services and benefit determinations for post-acute care programs including SNF, home health and DME. You will report to the Manager of Utilization Management and be part of the One Home/Home Solutions Utilization Management team.

The role requires an active Compact RN license, over one year of clinical RN experience, and a passion for improving member experiences.

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical RN experience 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 coordination, documentation and communication of medical services and benefit administration determinations.
• Using established medical criteria, you will make determinations based on information provided by the attending physician 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 operating goals, including their linkages to related areas.

Skills

RN license

Clinical experience

Patient focus

Education

BSN

Bachelor's degree

Job description

Humana in Wisconsin is seeking an Utilization Management Registered Nurse to interpret and support medical services and benefit determinations for post-acute care programs including SNF, home health and DME. You will report to the Manager of Utilization Management and be part of the One Home/Home Solutions Utilization Management team.

The role requires an active Compact RN license, over one year of clinical RN experience, and a passion for improving member experiences.