Remote Utilization Management RN: Care Coordination

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

Job summary

Humana is seeking a Utilization Management Registered Nurse to support coordination, documentation, and communication of medical services and benefit determinations for post-acute care, including SNF, home health, and DME. You will report to the Manager of Utilization Management as part of the One Home/Home Solutions UM team, delivering care in the most appropriate setting.

You will use established criteria to determine care, complete requests within processing time frames, and communicate with

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as an RN in a hospital, SNF, Home Health, or acute care setting.
• Must be passionate about contributing to an organization focused on improving consumer experiences.

Responsibilities

• Use clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit administration determinations.
• Using established medical criteria, make determinations based on information provided by the attending physician and other care providers.
• Complete request determinations within established processing time frames (e.g., 10 reviews per day).
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Help deliver coordinated care for our members.
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.

Skills

RN license

Clinical nursing

Remote work experience

Communication skills

Education

BSN

Bachelor's degree in related field

Job description

Humana is seeking a Utilization Management Registered Nurse to support coordination, documentation, and communication of medical services and benefit determinations for post-acute care, including SNF, home health, and DME. You will report to the Manager of Utilization Management as part of the One Home/Home Solutions UM team, delivering care in the most appropriate setting.

You will use established criteria to determine care, complete requests within processing time frames, and communicate with