Remote Utilization Management RN - Care Coordination Expert

Humana; United (LA); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Disability and life insurance

Job summary

Humana is seeking a Remote 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, and DME). You will report to the Manager of Utilization Management as part of the One Home/Home Solutions UM team.

The role requires an RN license and clinical post-acute experience, with a focus on improving member experiences.

Qualifications

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

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Use established medical criteria to make determinations based on information from attending physicians and other care providers.
• Complete request determinations within established processing time frames.
• Communicate with providers, members or other parties to facilitate care and treatment.
• Deliver coordinated care for our members.

Skills

RN license

Clinical nursing

Post-acute care

Education

BSN preferred

Job description

Humana is seeking a Remote 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, and DME). You will report to the Manager of Utilization Management as part of the One Home/Home Solutions UM team.

The role requires an RN license and clinical post-acute experience, with a focus on improving member experiences.