Remote Utilization Management Nurse — Post-Acute Care

Humana; Jackson (MS); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking a dedicated Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations. You will work remotely, interfacing with providers and members to ensure appropriate care.

A compact RN license in your state is required, along with 1+ year RN experience in relevant settings and knowledge of utilization review guidelines. The role supports home-based and post-acute care coordination, with travel minimal and background screening per

Qualifications

• Compact RN license in your state of residence.
• 1+ year RN experience in hospital/SNF/home health/acute care.
• Experience in utilization management or utilization review.
• Knowledge of Milliman Care Guidelines or InterQual.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Communicate with providers, members and other parties to facilitate care and treatment.
• Deliver coordinated care for Humana's members.
• Work with the Utilization Management team to ensure appropriate level of care and settings.

Skills

RN license (Compact)

Education

BSN or bachelor's degree

Tools

Milliman Care Guidelines

InterQual

Job description

Humana is seeking a dedicated Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations. You will work remotely, interfacing with providers and members to ensure appropriate care.

A compact RN license in your state is required, along with 1+ year RN experience in relevant settings and knowledge of utilization review guidelines. The role supports home-based and post-acute care coordination, with travel minimal and background screening per