Remote Utilization Management RN

Humana; Town of Florida (NY); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Medical, dental, vision benefits

401(k) retirement plan

Job summary

Humana is seeking an Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care. You will work remotely, reporting to the Manager of Utilization Management, and support SNF, home health, and DME coordination.

Requirements include an active RN license in your state and 1+ year of clinical RN experience in relevant settings. Preferred candidates have UM/utilization review experience, knowledge of Milliman Care Guidelines or

Qualifications

• Active RN license in state of residence (Compact preferred).
• 1+ year RN experience in hospital/SNF/home health/acute care.
• BSN or related degree preferred; strong communication skills.

Responsibilities

• Interpret and support coordination of medical services and benefit determinations.
• Make determinations using established medical criteria from provider information.
• Communicate with providers and members to facilitate care and treatment.
• Complete request determinations within established timelines.
• Understand broader department and organizational goals.

Skills

RN Experience

Utilization mgmt

Remote work

Communication

Education

BSN or related degree

RN license (Compact)

Tools

Milliman Care Guidelines

InterQual

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care. You will work remotely, reporting to the Manager of Utilization Management, and support SNF, home health, and DME coordination.

Requirements include an active RN license in your state and 1+ year of clinical RN experience in relevant settings. Preferred candidates have UM/utilization review experience, knowledge of Milliman Care Guidelines or