Remote Utilization Management RN

Humana; Charleston (WV); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Remote work option

Internet expense stipend (CA/IL/MT/SD)

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations for post-acute care services including SNF, Home Health, and DME.

You will collaborate with providers and members to facilitate care, meet processing timelines, and align with organizational goals. Remote options with occasional travel are available as described in the posting.

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical RN experience in a hospital, SNF, home health, or acute care setting.
• Preferred: experience in utilization management/utilization review for a health plan or acute care setting.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit administration determinations.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Complete request determinations within established processing time frames and inform relevant stakeholders.

Skills

RN license

Clinical experience

Remote work experience

Tools

Milliman Care Guidelines

InterQual

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations for post-acute care services including SNF, Home Health, and DME.

You will collaborate with providers and members to facilitate care, meet processing timelines, and align with organizational goals. Remote options with occasional travel are available as described in the posting.