Remote Utilization Management Nurse (RN)

Humana; South Dakota; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Home/Hybrid work option

Competitive benefits

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team, focusing on post-acute care services (SNF, Home Health, DME).

The role emphasizes using clinical nursing skills to determine medical necessity, communicate with providers, and ensure

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical RN experience in hospital, SNF, Home Health, or acute care.
• Passionate about contributing to an organization focused on improving consumer experiences.

Responsibilities

• Use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Using established medical criteria, 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.

Skills

RN license

Clinical experience

Remote work

Education

BSN or Bachelor's degree

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team, focusing on post-acute care services (SNF, Home Health, DME).

The role emphasizes using clinical nursing skills to determine medical necessity, communicate with providers, and ensure