Remote Utilization Management RN

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

Benefits offered by this job

Bonus incentive plan

Remote work

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 work with the One Home/Home Solutions Utilization Management team to ensure the right care at the right setting for post-acute services including SNF, Home Health and DME.

Responsibilities include applying established medical criteria, communicating with providers and members, and delivering coordinated care

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical experience as a RN in 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 coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria based on information from physicians and care providers.
• Complete request determinations within established processing time frames.

Skills

RN license (Compact)

Clinical nursing experience

Patient-centered care

Education

BSN preferred

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 work with the One Home/Home Solutions Utilization Management team to ensure the right care at the right setting for post-acute services including SNF, Home Health and DME.

Responsibilities include applying established medical criteria, communicating with providers and members, and delivering coordinated care