Remote Utilization Management RN — Care Coordination Expert

Humana; West Virginia; On-site; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana is hiring a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communications for medical services and benefit determinations. This remote role reports to the Manager of Utilization Management and sits on the One Home/Home Solutions Utilization Management team, overseeing SNF, Home Health, and DME related activities to ensure appropriate care settings.

Responsibilities include applying clinical criteria, making determinations, processing

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical nursing experience 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 coordination, documentation and communication of medical services and benefit determinations.
• Using established medical criteria, make determinations based on information from 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.
• Help deliver coordinated care for members.
• Understand department, segment, and organizational strategy and operating goals.

Skills

Compact RN license

Clinical nursing experience

Remote work experience

MDS Coordinator experience

Discharge planning experience

Medicare/Medicaid experience

Call center or triage experience

Education

BSN or bachelor's degree in a related field

Job description

Humana is hiring a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communications for medical services and benefit determinations. This remote role reports to the Manager of Utilization Management and sits on the One Home/Home Solutions Utilization Management team, overseeing SNF, Home Health, and DME related activities to ensure appropriate care settings.

Responsibilities include applying clinical criteria, making determinations, processing