Remote Utilization Management RN | Care Coordination

Humana Inc; Augusta (ME); On-site; USD 71,000 - 98,000; Full time

Benefits offered by this job

Remote work options

Bonus incentive plan

Job summary

Humana Inc. invites an Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations.

You report to the Manager of Utilization Management and support the One Home/Home Solutions Utilization Management team, overseeing post-acute care services including SNF, Home Health and DME. The role emphasizes applying clinical criteria to make determinations, communicating with providers and members, and

Qualifications

• Must hold Compact RN license in state of residence.
• >1 year RN clinical experience in hospital/SNF/Home Health/acute care.
• Must be passionate about contributing to an organization focused on consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and determinations.
• Make determinations using established medical criteria based on physician information.
• Complete request determinations within established processing time frames.
• Communicate with providers, members, or other parties to facilitate care.

Skills

RN license (Compact)

RN clinical experience

Patient-centered care

Education

BSN or related degree

Job description

Humana Inc. invites an Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations.

You report to the Manager of Utilization Management and support the One Home/Home Solutions Utilization Management team, overseeing post-acute care services including SNF, Home Health and DME. The role emphasizes applying clinical criteria to make determinations, communicating with providers and members, and