Remote Utilization Management RN – Care Coordination

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

Benefits offered by this job

Bonus incentive plan

Work from home

Job summary

Humana 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 as a member of the One Home/Home Solutions Utilization Management team, which oversees post-acute care services including SNF, home health, and DME.

You will use clinical nursing skills to determine medical necessity and coordinate care, with potential remote

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 setting.
• Passionate about contributing to an organization focused on improving consumer experiences.
• Preferred: utilization management/utilization review experience in health plans or acute care.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria based on info from attending physicians and others.
• Complete request determinations within established processing time frames.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Deliver coordinated care for members.
• Understand department and organizational strategies and linkages to related areas.

Skills

RN license

RN experience

Remote work experience

Acute care exposure

BSN or related degree

Education

BSN or bachelor’s degree in a related field

Job description

Humana 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 as a member of the One Home/Home Solutions Utilization Management team, which oversees post-acute care services including SNF, home health, and DME.

You will use clinical nursing skills to determine medical necessity and coordinate care, with potential remote