Remote Utilization Management RN - Care Coordination

Humana; Iowa City (IA); À distance; USD 71 000 - 98 000; Plein temps

Résumé du poste

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations for post-acute care services including SNF, Home Health, and DME. You will work with physicians and care teams to ensure appropriate care levels and timely determinations.

The role supports a remote workforce with travel for training or meetings as needed, and requires strong collaboration with providers and members to

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as an RN in a hospital, SNF, Home Health, or acute care setting.

Responsabilités

• Interpret and support coordination, documentation and communication of medical services and benefit administration determinations.
• Use established medical criteria to make determinations based on information from the physician and care providers.
• Complete request determinations within established processing time frames.
• Communicate with providers, members and other parties to facilitate care and treatment.

Connaissances

RN license

RN experience

Formation

BSN or related bachelor's

Description du poste

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations for post-acute care services including SNF, Home Health, and DME. You will work with physicians and care teams to ensure appropriate care levels and timely determinations.

The role supports a remote workforce with travel for training or meetings as needed, and requires strong collaboration with providers and members to