Remote Utilization Management RN: Care Coordination

Humana; Nebraska; 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 report to the Manager of Utilization Management on the One Home/Home Solutions Utilization Management team supporting post-acute care services including SNF, Home Health, and DME.

Responsibilities include applying clinical criteria, making determinations based on physician information, and communicating with

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

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• 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 and treatment.
• Help deliver coordinated care for members.
• Understand department, segment, and organizational strategy and goals and linkages to related areas.

Skills

RN license in state

Clinical RN experience

Communication with providers/members

Education

BSN or related bachelors

Tools

InterQual criteria

Milliman Care Guidelines

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 report to the Manager of Utilization Management on the One Home/Home Solutions Utilization Management team supporting post-acute care services including SNF, Home Health, and DME.

Responsibilities include applying clinical criteria, making determinations based on physician information, and communicating with