Remote Utilization Management RN: Care Coordination

Humana Inc; Frankfort (KY); On-site; 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 care coordination and benefit determinations. You will work with physicians and care providers to ensure appropriate care across SNF, home health, and DME, while aligning with organizational goals.

The role requires an active RN license, 1+ year of clinical RN experience, and familiarity with medical necessity criteria. Experience in utilization management or remote roles is a plus.

Qualifications

• Must hold Compact RN license in state of residence.
• Over 1 year of RN clinical experience in hospital/SNF/home health/acute care.
• Preferred experience in utilization management and remote roles.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria from physicians and care providers.
• Complete request determinations within set processing time frames.
• Communicate with providers and members to facilitate care and treatment.
• Contribute to delivering coordinated care and understand organizational strategy.

Skills

RN license

Clinical nursing experience

Communication with providers

Remote-friendly

Education

BSN or bachelor's degree

Tools

Milliman Care Guidelines

InterQual

Job description

Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support care coordination and benefit determinations. You will work with physicians and care providers to ensure appropriate care across SNF, home health, and DME, while aligning with organizational goals.

The role requires an active RN license, 1+ year of clinical RN experience, and familiarity with medical necessity criteria. Experience in utilization management or remote roles is a plus.