Remote Utilization Management RN – Care Coordination

Humana; Oklahoma; 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 work within the One Home/Home Solutions Utilization Management team, handling post-acute care services including SNF, Home Health and DME, aiming to ensure members receive appropriate care in the right setting.

This remote role requires US RN licensure in the state of residence and at least one year of clinical

Qualifications

• Must hold Compact RN license in state of residence.
• Greater than one year of clinical RN experience in hospital, SNF, home health, or acute care.
• Passionate about improving consumer experiences in health care.

Responsibilities

• Interpret and support coordination, documentation, and communication of medical services and benefit determinations.
• Make determinations based on established medical criteria using physician information.
• Complete request determinations within established processing time frames.
• Communicate with providers and members to facilitate care and treatment.
• Deliver coordinated care and align with department and organizational goals.

Skills

RN license

Clinical RN experience

Utilization management

Interqual knowledge

Milliman guidelines

Remote work

MDS Coordinator

Medicare/Medicaid experience

Call center experience

BSN

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. You will work within the One Home/Home Solutions Utilization Management team, handling post-acute care services including SNF, Home Health and DME, aiming to ensure members receive appropriate care in the right setting.

This remote role requires US RN licensure in the state of residence and at least one year of clinical