Remote Utilization Management RN — Care Coordination

Humana Inc; Helena (MT); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. seeks 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 and serve on the One Home/Home Solutions UM team focused on post-acute care services. You will review cases using established criteria, communicate with providers and members, and help deliver coordinated care while aligning with organizational goals and

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical experience as an RN in hospital, SNF, Home Health, or acute care setting.
• Must be passionate about contributing to an organization focused on improving consumer experiences.
• BSN or bachelor's degree in a related field is preferred.

Responsibilities

• Use clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit administration determinations.
• Make determinations based on established medical criteria using information from 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 members.
• Understand department, segment, and organizational strategy and goals and their links to related areas.

Skills

RN license (Compact)

Clinical nursing experience

Education

BSN or related bachelor's degree

Tools

Milliman Care Guidelines

Interqual

Job description

Humana Inc. seeks 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 and serve on the One Home/Home Solutions UM team focused on post-acute care services. You will review cases using established criteria, communicate with providers and members, and help deliver coordinated care while aligning with organizational goals and