Remote Utilization Management RN - Care Coordination

Humana Inc; Phoenix (AZ); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations.

You will report to the Manager of Utilization Management and support post-acute care services across SNF, home health, and DME to ensure members receive appropriate care in the right setting. The role requires an active compact RN license, over one year of RN experience in hospital/SNF/home health/acute care, and a

Qualifications

• Must hold Compact RN license in your state of residence
• Greater than one year of clinical RN experience in hospital, SNF, home health or acute care
• 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 with information from providers
• Complete request determinations within established processing time frames
• Communicate with providers, members, or other parties to facilitate care
• Help deliver coordinated care for members
• Understand department and organizational strategy and goals

Skills

RN license

Clinical RN experience

Patient-centered care

Remote work experience

Education

BSN or related bachelor's

Tools

Milliman Care Guidelines

Job description

Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations.

You will report to the Manager of Utilization Management and support post-acute care services across SNF, home health, and DME to ensure members receive appropriate care in the right setting. The role requires an active compact RN license, over one year of RN experience in hospital/SNF/home health/acute care, and a