Remote Utilization Management RN — Care Coordination Leader

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

Benefits offered by this job

Medical, dental & vision benefits

401(k) retirement savings plan

Paid time off & holidays

Short-term and long-term disability

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. This 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 established criteria to determine medical necessity, communicate with providers and members, and deliver coordinated care.

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical experience as an 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

• Use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Using established medical criteria, make determinations 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

RN license

Clinical experience

Remote work

Medicare/Medicaid experience

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. This 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 established criteria to determine medical necessity, communicate with providers and members, and deliver coordinated care.