Remote Utilization Management Nurse: Care Coordination

Santa Barbara Cottage Hospital; United States; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus eligible

Job summary

Humana is seeking a Utilization Management Nurse 2 to support coordination, documentation and communication of medical services and benefit determinations. The role involves independent interpretation of criteria and guidelines to ensure optimal patient care and services.

Position may be remote with occasional travel to Humana offices. Requires Florida licensure (RN with 3+ years or LPN with 5+ years) and Florida residency; BSN preferred and eligibility for a bonus plan is noted.

Qualifications

• Licensed RN with at least 3 years in acute, skilled, long-term care or rehab settings.
• LPN with at least 5 years in acute care, skilled, long-term care or rehab settings.
• Must reside in the state of Florida with license in Florida and no disciplinary action.
• BSN or related bachelor's degree preferred; prior utilization management experience is a plus.

Responsibilities

• Coordinate and communicate with providers, members, and other parties to facilitate appropriate care and services.
• Interpret criteria, policies, and procedures to determine best treatment and services.
• Make independent decisions within established guidelines and follow department procedures.
• Understand organizational strategy and linkages to related areas; travel to Humana offices may be required.

Skills

Clinical nursing skills

Utilization management

Independent critical thinking

Provider and member communication

Education

RN license (state of FL)

LPN license (state of FL)

BSN preferred

Job description

Humana is seeking a Utilization Management Nurse 2 to support coordination, documentation and communication of medical services and benefit determinations. The role involves independent interpretation of criteria and guidelines to ensure optimal patient care and services.

Position may be remote with occasional travel to Humana offices. Requires Florida licensure (RN with 3+ years or LPN with 5+ years) and Florida residency; BSN preferred and eligibility for a bonus plan is noted.