Remote Utilization Management RN - Care Coordination

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

Benefits offered by this job

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support medical services coordination, documentation and benefit determinations. You will work with physicians and care teams to ensure appropriate care settings for members, including SNF, home health and DME, reporting to the Manager of Utilization Management.

Responsibilities include applying criteria to make determinations, communicating with providers and members, and meeting processing timelines.

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one 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

• Interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Using established medical criteria, make determinations based on information provided by the attending physician and other care providers.
• Complete request determinations within established processing time frames.

Skills

RN license

Clinical RN experience

Utilization management

Remote / telework experience

MDS Coordinator / discharge planning

Medicare/Medicaid knowledge

Call center / triage experience

Education

BSN or bachelor's degree in a related field

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support medical services coordination, documentation and benefit determinations. You will work with physicians and care teams to ensure appropriate care settings for members, including SNF, home health and DME, reporting to the Manager of Utilization Management.

Responsibilities include applying criteria to make determinations, communicating with providers and members, and meeting processing timelines.