Remote Utilization Management RN — Care Coordination

Humana; Annapolis (MD); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations. The role supports post-acute care—SNF, home health, and DME—while guiding care decisions and documentation for Humana's members.

You will work with care providers, communicate to facilitate treatment, and leverage prior nursing experience in a fully remote, metrics-driven environment. A BSN or similar degree is required.

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical RN experience in hospital, SNF, Home Health, or acute care.
• Experience in utilization management or utilization review for a health plan or acute care setting.
• Basic knowledge of medical necessity criteria (Milliman Care Guidelines or InterQual).
• Experience in a fully remote, metrics-focused role.

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.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Help deliver coordinated care for Humana members.

Skills

RN license

Remote work exp

MDS coordination

Discharge planning

Education

BSN or bachelor's degree

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations. The role supports post-acute care—SNF, home health, and DME—while guiding care decisions and documentation for Humana's members.

You will work with care providers, communicate to facilitate treatment, and leverage prior nursing experience in a fully remote, metrics-driven environment. A BSN or similar degree is required.