Remote Utilization Management RN – Care Coordination Expert

Humana; Maryland; Teletrabalho; USD 71 000 - 98 000; Tempo integral

Resumo da oferta

Humana is seeking a dedicated Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care across SNF, Home Health and DME. You will work under the Manager of Utilization Management as part of the One Home/Home Solutions team.

Responsibilities include making determinations using Milliman/Interqual criteria, communicating with providers and members, and contributing to coordinated

Qualificações

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical RN experience in hospital/SNF/Home Health/acute care.
• Previous experience in utilization management/review for a health plan or acute care setting
• Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
• Experience working in a fully remote, metrics-focused role
• Experience as an MDS Coordinator or discharge planner in an acute care setting
• Experience as an RN for a Medicare Certified Home Health agency
• Health Plan or Medicare/Medicaid Experience
• Call center or triage experience
• BSN or bachelor's degree in a related field

Responsabilidades

• Interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Make determinations based on Milliman Care Guidelines or Interqual.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Help deliver coordinated care for our members.

Conhecimentos

RN license

Clinical experience

Utilization management

Medicare/Medicaid knowledge

MDS Coordinator

Call center experience

BSN or Bachelor's degree

Formação académica

BSN or Bachelor's degree

Descrição da oferta de emprego

Humana is seeking a dedicated Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care across SNF, Home Health and DME. You will work under the Manager of Utilization Management as part of the One Home/Home Solutions team.

Responsibilities include making determinations using Milliman/Interqual criteria, communicating with providers and members, and contributing to coordinated