Remote Utilization Management RN - Care Coordination

Humana Inc; Santa Fe (NM); Teletrabalho; USD 71 000 - 98 000; Tempo integral

Resumo da oferta

Humana Inc. seeks a Utilization Management RN to interpret clinical data and support coordination, documentation and communication of medical services and benefit determinations. You will work with the One Home/Home Solutions UM team to ensure appropriate post-acute care in the right setting.

Qualifications include an active Compact RN license and over one year of clinical RN experience. Preference is given to those with UM experience, knowledge of care criteria, and a remote, metrics-focused

Qualificações

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical RN experience in a hospital, SNF, Home Health, or acute care setting.
• Must be passionate about contributing to an organization focused on improving consumer experiences.
• Preferred: experience in utilization management/utilization review.
• Preferred: knowledge of Milliman Care Guidelines or Interqual.
• Preferred: experience in a fully remote, metrics-focused role.
• Preferred: MDS Coordinator or discharge planner experience.
• Preferred: RN for a Medicare Certified Home Health agency.
• Preferred: Health Plan or Medicare / Medicaid experience.
• Preferred: call center or triage experience.
• Preferred: BSN or bachelor’s degree

Responsabilidades

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations based on information from the attending physician and other care providers using established medical criteria.
• 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 our members.
• Understand department and organizational strategy and operating goals.

Conhecimentos

RN license

Clinical nursing

Remote work experience

Formação académica

BSN or bachelor’s degree

Descrição da oferta de emprego

Humana Inc. seeks a Utilization Management RN to interpret clinical data and support coordination, documentation and communication of medical services and benefit determinations. You will work with the One Home/Home Solutions UM team to ensure appropriate post-acute care in the right setting.

Qualifications include an active Compact RN license and over one year of clinical RN experience. Preference is given to those with UM experience, knowledge of care criteria, and a remote, metrics-focused