Remote Utilization Management RN: Care Coordination

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

Benefits offered by this job

Medical, dental, vision benefits

401(k) retirement savings

Paid time off

Job summary

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination of medical services and benefit determinations within the One Home/Home Solutions Utilization Management team. This team manages post-acute care services, including Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME).

The team’s goal is to ensure members receive the appropriate level of care in the most appropriate setting.

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical RN experience 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.
• Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers
• Complete request determinations within established processing time frames.
• You will communicate with providers, members, or other parties to facilitate care and treatment.
• You will help deliver coordinated care for our members
• You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.

Skills

RN licensure

Clinical RN experience

Consumer experience focus

Education

BSN or related degree

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination of medical services and benefit determinations within the One Home/Home Solutions Utilization Management team. This team manages post-acute care services, including Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME).

The team’s goal is to ensure members receive the appropriate level of care in the most appropriate setting.