Remote Utilization Management RN: Care Coordination

Humana; Portland (ME); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. This remote, work-at-home position focuses on post-acute care services including SNF, Home Health and DME, with occasional travel to training or meetings.

Responsibilities include applying medical criteria, making determinations, and communicating with providers and members to ensure appropriate care.

Qualifications

• Must hold Compact RN license in state of residence.
• More than one year of clinical RN experience in hospital, SNF, Home Health, or acute care.
• Preferred experience in utilization management/utilization review for a health plan or acute care setting.

Responsibilities

• Interpret and support the coordination, documentation and communication of medical services and benefit determinations.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Deliver coordinated care for members and understand department, segment, and organizational goals.

Skills

RN license

Clinical experience

Remote work experience

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. This remote, work-at-home position focuses on post-acute care services including SNF, Home Health and DME, with occasional travel to training or meetings.

Responsibilities include applying medical criteria, making determinations, and communicating with providers and members to ensure appropriate care.