Remote Utilization Management RN - Care Coordination

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

Job summary

Humana seeks an experienced Utilization Management RN to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care. You will work with providers and members to facilitate care and ensure appropriate settings.

Required: compact RN license, 1+ year hospital/SNF/Home Health experience, UM experience, knowledge of criteria such as InterQual or Milliman, and a BSN or related degree. Remote work eligible.

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
• Previous experience in utilization management/utilization review for a health plan or acute care setting.
• Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
• Experience working in a fully remote, metrics-focused role.
• Experience as an MDS Coordinator or discharge planner in an acute care setting.
• Experience as an 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

Responsibilities

• Interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Help deliver coordinated care for our members.

Skills

RN license

Remote work experience

Call center or triage experience

MDS Coordinator / discharge planning

Medicare/Medicaid experience

Utilization management experience

Milliman Care Guidelines / Interqual

Education

BSN or bachelor's degree in related field

Job description

Humana seeks an experienced Utilization Management RN to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care. You will work with providers and members to facilitate care and ensure appropriate settings.

Required: compact RN license, 1+ year hospital/SNF/Home Health experience, UM experience, knowledge of criteria such as InterQual or Milliman, and a BSN or related degree. Remote work eligible.