Remote Utilization Management RN: Care Coordination Lead

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

Benefits offered by this job

Home/Hybrid option

Internet expense support

Telephone equipment provided

Travel for training/meetings

Job summary

Humana is seeking an Utilization Management Registered Nurse to interpret and coordinate medical services, document determinations, and support benefit administration for post-acute care. You will report to the Manager of Utilization Management and be part of the One Home/Home Solutions team focused on SNF, Home Health, and DME.

This is a remote role with occasional travel for training or meetings. Required RN license in your state and 1+ year of clinical RN experience; BSN preferred; excellent

Qualifications

• Must hold Compact RN license in your state.
• More than one year of clinical RN experience in hospital, SNF, home health or acute care.
• BSN or bachelor's degree in a related field (preferred).

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Determine determinations using established medical criteria based on information from attending physicians and other 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 members.
• Understand department, segment, and organizational strategy and operating goals and linkages.

Skills

RN license

Clinical experience

Patient focus

Education

Bachelor's degree

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and coordinate medical services, document determinations, and support benefit administration for post-acute care. You will report to the Manager of Utilization Management and be part of the One Home/Home Solutions team focused on SNF, Home Health, and DME.

This is a remote role with occasional travel for training or meetings. Required RN license in your state and 1+ year of clinical RN experience; BSN preferred; excellent