Remote Utilization Management RN | Care Coordination

Humana; Tennessee; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Competitive benefits

Home/Hybrid work options

Job summary

Humana is seeking a dedicated Utilization Management Registered Nurse to interpret and support clinical and administrative determinations for post-acute care services including SNF, Home Health, and DME.

You will work from home or hybrid, reporting to the Manager of Utilization Management, and collaborate with a dedicated team to ensure members receive appropriate care in the right setting. Travel to Humana offices may be required occasionally.

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of RN clinical experience in hospital, SNF, home health or acute care.
• Passionate about contributing to a consumer-focused organization.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria based on info from physicians and care providers.
• Complete request determinations within established processing time frames.
• Communicate with providers, members and other parties to facilitate care.
• Deliver coordinated care aligned with department and organizational goals.

Skills

RN license

Clinical nursing skills

Communication

Remote work experience

Education

Nursing degree (RN)

Tools

InterQual

Milliman Care Guidelines

Job description

Humana is seeking a dedicated Utilization Management Registered Nurse to interpret and support clinical and administrative determinations for post-acute care services including SNF, Home Health, and DME.

You will work from home or hybrid, reporting to the Manager of Utilization Management, and collaborate with a dedicated team to ensure members receive appropriate care in the right setting. Travel to Humana offices may be required occasionally.