Remote Utilization Management Nurse – Care Coordinator (LA)

IntelliResume; Louisiana (MO); On-site; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Paid time off

Parental leave

Job summary

Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations. This remote role requires a Louisiana RN license and offers a stable, full-time schedule with standard business hours.

The candidate will interpret guidelines, coordinate with providers and members, and make independent decisions to ensure quality patient care within Medicaid Care Management.

Qualifications

• RN license in Louisiana required.
• 3+ years of varied RN nursing experience.
• Experience in Utilization Management Review or Prior Authorization preferred.
• Medicare/Medicaid experience a plus.

Responsibilities

• Interpret criteria, policies, and procedures using clinical knowledge.
• Coordinate with providers, members, and other parties to facilitate care.
• Make decisions regarding work methods with minimal direction.
• Follow established guidelines and procedures.
• Support the Medicaid Care Management Team.
• Participate in training programs spanning approximately four to six weeks.

Skills

RN nursing experience

Utilization Management

Prior Authorization

Medicare/Medicaid experience

Education

RN License Louisiana

Job description

Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations. This remote role requires a Louisiana RN license and offers a stable, full-time schedule with standard business hours.

The candidate will interpret guidelines, coordinate with providers and members, and make independent decisions to ensure quality patient care within Medicaid Care Management.