Remote Utilization Management RN — Care Coordination Expert

Humana; Oklahoma; Remote; USD 71.000 - 98.000; Vollzeit

Zusammenfassung

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

You will determine medical necessity using established criteria, communicate with providers and members, and

Qualifikationen

• 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.
• Must be passionate about contributing to an organization focused on improving consumer experiences.

Aufgaben

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations based on information from physicians and care providers using established criteria.
• Complete request determinations within processing time frames (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 goals and their linkages.

Kenntnisse

RN license

Clinical nursing

Care coordination

Ausbildung

Compact RN license

Jobbeschreibung

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

You will determine medical necessity using established criteria, communicate with providers and members, and