Remote Utilization Management RN — Care Coordination Expert

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

Job summary

Humana seeks an experienced Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit determinations.

This remote role reports to the Manager of Utilization Management and serves on the One Home/Home Solutions UM team, covering post-acute care services including SNF, Home Health and DME. The position requires a current RN license and at least 1 year of clinical RN experience.

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
• Must be passionate about contributing to an organization focused on improving consumer experiences.

Responsibilities

• Use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers
• You will complete request determinations within established processing time frames.

Skills

RN license

Clinical RN experience

Remote work experience

Communication skills

Education

BSN preferred

Job description

Humana seeks an experienced Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit determinations.

This remote role reports to the Manager of Utilization Management and serves on the One Home/Home Solutions UM team, covering post-acute care services including SNF, Home Health and DME. The position requires a current RN license and at least 1 year of clinical RN experience.