Remote Utilization Management Nurse (RN)

Humana Inc; Kentucky; Hybrid; USD 71,000 - 98,000; Full time

Job summary

Humana Inc. is seeking an Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting and communicating medical services and benefit determinations. The role involves interpretation of criteria and independent decision-making to provide appropriate care for members.

This remote, patient-facing position may require occasional travel to Humana offices for training or meetings, and includes a TB screening requirement as part of Humana’s program.

Qualifications

• Bachelor's degree and RN license in the state of Ohio.
• 3+ years of medical-surgical, heart, lung or critical care nursing experience.
• Utilization management experience.
• Clinical experience in acute care, skilled or rehabilitation settings.

Responsibilities

• Coordinate and communicate with providers, members and other parties to facilitate optimal care and treatment.
• Interpret criteria, policies and procedures to determine appropriate course of action.
• Document and support medical services and benefit determinations.
• Support organizational objectives while complying with TB screening and other program requirements.

Education

Bachelor's degree in Nursing

RN license (OH)

Job description

Humana Inc. is seeking an Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting and communicating medical services and benefit determinations. The role involves interpretation of criteria and independent decision-making to provide appropriate care for members.

This remote, patient-facing position may require occasional travel to Humana offices for training or meetings, and includes a TB screening requirement as part of Humana’s program.