Remote Utilization Management RN: Care Coordination Lead

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

Benefits offered by this job

Medical, dental and vision benefits

Bonus incentive plan

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You will work with the One Home/Home Solutions Utilization Management team to manage post-acute care services across SNF, home health, and DME.

You will determine treatments using established criteria, communicate with providers and members, and ensure timely processing of reviews while aligning with organizational

Qualifications

• Must hold Compact RN license in your state of residence.
• Over one year of RN clinical experience in hospital, SNF, Home Health, or acute care.
• Passionate about contributing to an organization focused on improving consumer experiences.

Responsibilities

• Interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Make determinations using established medical criteria based on information provided by the attending physician 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 our members.
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.

Skills

Clinical nursing skills

RN license in state of residence

Utilization management

Medical criteria knowledge (Milliman/|

Education

BSN or Bachelor's degree in a related field

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You will work with the One Home/Home Solutions Utilization Management team to manage post-acute care services across SNF, home health, and DME.

You will determine treatments using established criteria, communicate with providers and members, and ensure timely processing of reviews while aligning with organizational