Remote Utilization Management RN — Care Coordination

Humana Inc; Dover (DE); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit determinations.

You will work with the One Home/Home Solutions Utilization Management team to ensure members receive appropriate care in the right setting. You will determine based on medical criteria, communicate with providers and members, and contribute to a team focused on improving consumer experiences while supporting

Qualifications

• Must hold Compact 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 the coordination, documentation and communication of medical services and benefit administration determinations.
• Make determinations using established medical criteria based on information from the attending 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.
• 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 experience

Patient care

Communication with providers

Healthcare quality

Education

BSN or bachelor's degree

Job description

Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit determinations.

You will work with the One Home/Home Solutions Utilization Management team to ensure members receive appropriate care in the right setting. You will determine based on medical criteria, communicate with providers and members, and contribute to a team focused on improving consumer experiences while supporting