Remote Utilization Management RN

Humana Inc; Augusta (ME); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a qualified Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations.

You will report to the Manager of Utilization Management and contribute to post-acute care coordination across SNF, Home Health, and DME settings. You will apply established medical criteria to make determinations, communicate with providers and members, and help ensure patients receive appropriate care in the right setting.

Qualifications

• Compact RN license in your state of residence.
• Over 1 year of clinical RN experience in hospital, SNF, or home health.
• Passionate about improving consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria with physician input.
• Complete request determinations within processing time frames.
• Communicate with providers, members, or other parties to facilitate care.
• Help deliver coordinated care for members.
• Align with department and organizational strategies.

Skills

RN licensure (Compact)

Clinical RN experience

Patient-focused care

Education

BSN or related bachelor's degree

Job description

Humana Inc. is seeking a qualified Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations.

You will report to the Manager of Utilization Management and contribute to post-acute care coordination across SNF, Home Health, and DME settings. You will apply established medical criteria to make determinations, communicate with providers and members, and help ensure patients receive appropriate care in the right setting.