Remote Utilization Management RN — Care Coordination

Humana; Georgia; A distancia; USD 71.000 - 98.000; Jornada completa

Descripción de la vacante

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, serving on the One Home/Home Solutions Utilization Management team focused on post-acute care services.

You will use clinical nursing skills to determine care needs, communicate with providers and members, and deliver coordinated care while aligning with

Formación

• Must hold Compact RN license in your state of residence.
• Over 1 year of RN clinical experience in hospital, SNF, home health or acute care.
• Passionate about contributing to an organization focused on improving consumer experiences.
• Preferred: experience in utilization management.
• Knowledge of medical necessity criteria such as Milliman or InterQual.
• Experience in a fully remote, metrics-focused role.
• Experience as an MDS Coordinator or discharge planner in an acute care setting.
• RN for a Medicare Certified Home Health agency.
• Health Plan or Medicare/Medicaid experience.
• Call center or triage experience.
• BSN or bachelor's degree in a related field.

Responsabilidades

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria from physicians and other care providers.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Help deliver coordinated care for our members and understand organizational strategy.

Conocimientos

Compact RN license

RN clinical experience

Remote/telework experience

Call center/triage experience

Customer-focused care

Educación

BSN or related bachelor's degree

Bachelor's degree in a related field

Descripción del empleo

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, serving on the One Home/Home Solutions Utilization Management team focused on post-acute care services.

You will use clinical nursing skills to determine care needs, communicate with providers and members, and deliver coordinated care while aligning with