Remote Utilization Management RN | Care Coordination

Humana; Lexington (KY); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You will work with physicians and care providers to make determinations using established criteria and complete requests within set timeframes.

Responsibilities include communicating with providers and members to facilitate care, delivering coordinated care, and aligning with department goals.

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.

Responsibilities

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

Skills

RN license

Clinical RN experience

Education

BSN or related degree

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You will work with physicians and care providers to make determinations using established criteria and complete requests within set timeframes.

Responsibilities include communicating with providers and members to facilitate care, delivering coordinated care, and aligning with department goals.