Remote Utilization Management RN: Care Coordination

Humana; Nashville (TN); 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 for post-acute care (SNF, Home Health, DME). Remote, full-time role with travel optional to Humana offices for training.

You will collaborate with physicians, providers and members, applying Milliman/Interqual criteria and contributing to efficient care delivery while supporting the organization’s patient-centered goals.

Qualifications

• Must hold Compact RN license in state of residence.
• Over 1 year of clinical RN experience in hospital/SNF/home health/acute care.
• Preferred: experience in utilization management or review in health plan or acute care.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria with input from physicians and other care providers.
• Communicate with providers, members or other parties to facilitate care and treatment.
• Support post-acute care coordination for SNF, home health and DME.

Skills

RN license

Remote work experience

Healthcare coordination

Communication

Education

BSN

Bachelor's degree

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care (SNF, Home Health, DME). Remote, full-time role with travel optional to Humana offices for training.

You will collaborate with physicians, providers and members, applying Milliman/Interqual criteria and contributing to efficient care delivery while supporting the organization’s patient-centered goals.