Remote Utilization Management RN: Care Coordination

Humana; Arkansas; On-site; 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 support coordination, documentation and communication of medical services and benefit determinations. You will report to the Manager of Utilization Management in a team handling post-acute care services including SNF, Home Health, and DME.

The role requires a compact RN license, 1+ year RN experience in relevant settings, and a commitment to improving member experiences.

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of RN experience in hospital, SNF, Home Health, or acute care setting.
• 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 from 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.
• Deliver coordinated care and align with department and organizational goals.

Skills

RN license compact

RN experience

Utilization management

Medical necessity criteria

Remote/work-from-home experience

MDS coordinator / discharge planning

Medicare/Medicaid experience

Call center / triage

BSN or related degree

Healthcare plan knowledge

Education

BSN or related bachelor's degree

RN license (state)

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 in a team handling post-acute care services including SNF, Home Health, and DME.

The role requires a compact RN license, 1+ year RN experience in relevant settings, and a commitment to improving member experiences.