Remote Utilization Management RN: Care Coordination

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

Benefits offered by this job

Bonus eligibility

Job summary

Humana is seeking an Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care, reporting to the Manager of Utilization Management. This remote role supports SNF, Home Health and DME, ensuring members receive appropriate care in the right setting.

The role emphasizes applying medical criteria, performing timely determinations, and communicating with providers and patients while aligning with organizational goals and

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.
• 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 and their linkages to related areas.

Skills

Utilization review

RN clinical experience

Education

Compact RN license

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care, reporting to the Manager of Utilization Management. This remote role supports SNF, Home Health and DME, ensuring members receive appropriate care in the right setting.

The role emphasizes applying medical criteria, performing timely determinations, and communicating with providers and patients while aligning with organizational goals and