Remote Utilization Management RN | Care Coordination

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

Benefits offered by this job

Bonus incentive plan

Job summary

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You’ll report to the Manager of Utilization Management and join the One Home/Home Solutions UM team managing post-acute care services including SNF, home health, and DME.

The role requires an active RN license, 1+ year RN experience, and a focus on consumer experience.

Qualifications

• Must hold Compact RN license in state of residence.
• Over one year of clinical RN experience in hospital, SNF, home health or acute care.
• Must be passionate about improving consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services
• Make determinations using established medical criteria based on physician information
• Complete request determinations within established processing time frames
• Communicate with providers, members or other parties to facilitate care
• Deliver coordinated care for Humana members
• Align department goals with organizational strategy

Skills

RN license

Clinical experience

Remote work experience

Education

BSN or related bachelor's degree

Tools

Milliman Care Guidelines

InterQual

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You’ll report to the Manager of Utilization Management and join the One Home/Home Solutions UM team managing post-acute care services including SNF, home health, and DME.

The role requires an active RN license, 1+ year RN experience, and a focus on consumer experience.