Remote Utilization Management RN – Care Coordination

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

Job summary

Utilization Management Registered Nurse at Humana uses clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care services including SNF, Home Health and DME.

You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team, focused on ensuring members receive appropriate care in the most suitable setting.

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical experience as an RN 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.
• 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 (e.g., 10 reviews per day).
• 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 their linkages to related areas.

Skills

Clinical nursing

Communication with providers

Patient care

Education

BSN or related bachelor's degree

Job description

Utilization Management Registered Nurse at Humana uses clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care services including SNF, Home Health and DME.

You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team, focused on ensuring members receive appropriate care in the most suitable setting.