Remote Utilization Management RN

Humana; Arizona; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Disability and life insurance

Job summary

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. The role reports to the Manager of Utilization Management as part of the One Home/Home Solutions Utilization Management team handling post-acute care services such as SNF, Home Health, and DME.

Responsibilities include applying medical criteria to determine care needs, completing determinations within time frames, and

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
• Must be 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, you will 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.
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.

Skills

RN license

Clinical RN experience

Remote work experience

Education

BSN or related bachelor degree

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. The role reports to the Manager of Utilization Management as part of the One Home/Home Solutions Utilization Management team handling post-acute care services such as SNF, Home Health, and DME.

Responsibilities include applying medical criteria to determine care needs, completing determinations within time frames, and