Remote Utilization Management RN - Care Coordination Expert

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

Benefits offered by this job

Bonus incentive plan

Remote/Work-from-home flexibility

Job summary

Humana is seeking an Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit determinations for post-acute care (SNF, Home Health, DME). You will report to the Manager of Utilization Management and support the One Home/Home Solutions UM team.

The role emphasizes remote work, strong clinical nursing skills, knowledge of medical necessity criteria, and a passion for improving consumer experiences; travel may

Qualifications

• RN license in state of residence (compact RN)
• 1+ year clinical RN experience in hospital, SNF, home health, or acute care
• Passion for 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 physician and care provider information
• Complete request determinations within established 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 members
• Understand department and organizational strategy and goals

Skills

RN license (Compact RN)

Clinical nursing experience

Utilization management experience

Education

BSN preferred

Tools

Milliman Care Guidelines

InterQual

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit determinations for post-acute care (SNF, Home Health, DME). You will report to the Manager of Utilization Management and support the One Home/Home Solutions UM team.

The role emphasizes remote work, strong clinical nursing skills, knowledge of medical necessity criteria, and a passion for improving consumer experiences; travel may