Remote Utilization Management RN – Care Coordination

Humana Inc; Jackson (MS); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work option

Job summary

Humana, Inc. 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 and support the One Home Solutions UM team focused on post-acute care (SNF, Home Health, DME). The role requires a valid RN license, 1+ year of clinical RN experience, and a commitment to improving member experiences.

Qualifications

• Must hold Compact RN license in your state of residence.
• >1 year of clinical RN experience in 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 attending physicians 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, including linkages to related areas.

Skills

RN license

Clinical nursing

Post-acute care experience

Remote work experience

Education

BSN or Bachelor's degree

Job description

Humana, Inc. 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 and support the One Home Solutions UM team focused on post-acute care (SNF, Home Health, DME). The role requires a valid RN license, 1+ year of clinical RN experience, and a commitment to improving member experiences.