Remote Utilization Management RN – Care Coordination Lead

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

Benefits offered by this job

Bonus incentive plan

Remote work options

Job summary

Humana’s Utilization Management team is hiring a Registered Nurse to interpret and support 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 collaborate with the One Home/Home Solutions UM team.

In this remote role, you will use established criteria to make determinations, communicate with providers and members, and help deliver coordinated care

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
• Must be passionate about contributing to an organization focused on improving consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit administration determinations.
• Make determinations using established medical criteria based on information from physicians and other care providers.
• Complete request determinations within established processing time frames and communicate with providers, members, or other parties to facilitate care and treatment.

Skills

RN license

Clinical RN experience

Remote work experience

Job description

Humana’s Utilization Management team is hiring a Registered Nurse to interpret and support 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 collaborate with the One Home/Home Solutions UM team.

In this remote role, you will use established criteria to make determinations, communicate with providers and members, and help deliver coordinated care