Remote Utilization Management RN: Care Coordination

Humana; New Hampshire; À distance; USD 71 000 - 98 000; Plein temps

Avantages offerts par ce poste

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Bonus incentive plan

Remote or hybrid work options

Résumé du poste

Humana is seeking an experienced Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care teams, including SNF, home health, and DME. You will work remotely with occasional travel to Humana offices for training or meetings.

You will use established criteria to make determinations, communicate with providers and members, and ensure care is delivered in the most appropriate setting while aligning with organizational goals.

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.

Responsabilités

• 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.
• You will complete request determinations within established processing time frames (e.g. 10 reviews per day).
• 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.

Connaissances

RN license

Clinical nursing experience

Patient care advocacy

Formation

BSN or bachelor's degree in a related field

Description du poste

Humana is seeking an experienced Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care teams, including SNF, home health, and DME. You will work remotely with occasional travel to Humana offices for training or meetings.

You will use established criteria to make determinations, communicate with providers and members, and ensure care is delivered in the most appropriate setting while aligning with organizational goals.