Remote Utilization Management RN

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

Benefits offered by this job

Bonus incentive plan

Work from home

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 be part of the One Home/Home Solutions Utilization Management team focused on post-acute care (SNF, Home Health, DME).

The role emphasizes using clinical nursing skills, applying medical criteria to determinations, and communicating with providers and members

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical experience as an 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

• Interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Use established medical criteria to 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 nursing experience

Remote work experience

Communication skills

Education

BSN or Bachelor's degree

Compact RN license

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 be part of the One Home/Home Solutions Utilization Management team focused on post-acute care (SNF, Home Health, DME).

The role emphasizes using clinical nursing skills, applying medical criteria to determinations, and communicating with providers and members