Remote Utilization Management RN | Care Coordination Expert

Humana

Wyoming

Remote

USD 71,000 - 98,000

Full time

31 hours ago

Be an early applicant

Get a reply from this employer

Your resume and cover letter, tailored to exactly what they’re hiring for.

Get past ATS filters

Benefits offered by this job

Bonus incentive plan

Remote work

Competitive benefits

Job summary

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

You will use clinical nursing skills to determine medical necessity and communicate with providers and members, contributing to

Qualifications

Must hold Compact RN license in your state of residence.
Over 1 year of clinical RN experience in hospital, SNF, home health, or acute care.
BSN or related degree preferred for advancement.

Responsibilities

Use clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit determinations.
Make determinations using established medical criteria based on information from physicians and care providers.
Complete request determinations within established processing time frames.
Communicate with providers, members and other parties to facilitate care and treatment.
Help deliver coordinated care for Humana members.
Understand how the department, segment and organization goals link to related areas.