Remote Utilization Management RN — Care Coordination

Emploive; Oklahoma City, Northern (OK, KY); Hybrid; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination of medical services and benefit determinations. You will work remotely, reporting to the Manager of Utilization Management, serving a post-acute care team including SNF, Home Health, and DME to ensure appropriate care settings.

You will use criteria to make determinations, complete processing within time frames, and communicate with providers and members to deliver coordinated care.

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as a RN 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 based on established medical criteria using information from physicians and care providers.
• Complete request determinations within established processing time frames (e.g., 10 reviews per day).
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Deliver coordinated care for our members.
• Understand department, segment, and organizational strategy and operating goals and their linkages to related areas.

Skills

Compact RN license

RN clinical experience

Patient-centered care

Education

BSN or related bachelor’s degree

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination of medical services and benefit determinations. You will work remotely, reporting to the Manager of Utilization Management, serving a post-acute care team including SNF, Home Health, and DME to ensure appropriate care settings.

You will use criteria to make determinations, complete processing within time frames, and communicate with providers and members to deliver coordinated care.