Remote Utilization Management RN — Care Coordination

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

Benefits offered by this job

Bonus incentive plan

Comprehensive benefits (medical, Rx, 2

401(k) retirement savings

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations for post-acute care (SNF, Home Health, DME). The role reports to the Manager of Utilization Management and is part of the One Home/Home Solutions Utilization Management team.

You will use established medical criteria to make determinations; complete requests within timeframes; and communicate with providers and members

Qualifications

• Must hold Compact RN license in your state of residence.
• Over 1 year of clinical RN experience in hospital/SNF/home health/acute care.
• Passionate about improving consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria based on information from physicians and other care providers.
• Complete request determinations within established processing timeframes (e.g., 10 reviews per day).
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Deliver coordinated care for our members.
• Understand department, segment, and organizational strategy and goals and their linkages to related areas.

Skills

RN license

clinical RN experience

patient care

Education

BSN or related bachelor degree

Bachelor degree

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations for post-acute care (SNF, Home Health, DME). The role reports to the Manager of Utilization Management and is part of the One Home/Home Solutions Utilization Management team.

You will use established medical criteria to make determinations; complete requests within timeframes; and communicate with providers and members