Remote Utilization Management RN: Care Coordination

Humana; Ohio; 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 for post-acute care such as SNF, Home Health, and DME.

The role reports to the Manager of Utilization Management and supports the One Home/Home Solutions Utilization Management team, with responsibilities including determining medical necessity, communicating with providers and delivering coordinated care.

Qualifications

• Must hold Compact RN license in state of residence.
• Greater than one year of 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 from attending physicians and care providers.
• 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 Humana members.
• Understand how department and organizational strategies link to related areas.

Skills

Clinical nursing skills

Communication with providers

Care coordination

Education

BSN or Bachelor's degree

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care such as SNF, Home Health, and DME.

The role reports to the Manager of Utilization Management and supports the One Home/Home Solutions Utilization Management team, with responsibilities including determining medical necessity, communicating with providers and delivering coordinated care.