Remote Utilization Management RN — Care Coordination

Humana Inc; New Jersey; Hybrid; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive

Job summary

Humana Inc is seeking a Utilization Management Registered Nurse to interpret and coord intakes for medical services and benefit determinations in a fully remote capacity. You will support post-acute care services across SNF, Home Health and DME, reporting to the Utilization Management Manager as part of the One Home/Home Solutions team.

You will apply clinical criteria to make determinations, communicate with providers and members, and complete reviews within set time frames while contributing

Qualifications

• Must hold Compact RN license in state of residence.
• 1+ year clinical RN experience in hospital/SNF/home health/acute care.
• Passionate about improving consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations based on established medical criteria using information from physicians and care providers.
• Complete request determinations within established processing time frames and communicate with providers, members, or other parties to facilitate care.
• Deliver coordinated care for members and understand department strategy and goals.

Skills

Clinical nursing

Remote work experience

Call center / triage

Medicare/Medicaid knowledge

Healthcare analytics / metrics

Education

BSN

Tools

Milliman Care Guidelines

InterQual

Job description

Humana Inc is seeking a Utilization Management Registered Nurse to interpret and coord intakes for medical services and benefit determinations in a fully remote capacity. You will support post-acute care services across SNF, Home Health and DME, reporting to the Utilization Management Manager as part of the One Home/Home Solutions team.

You will apply clinical criteria to make determinations, communicate with providers and members, and complete reviews within set time frames while contributing