Remote Utilization Management RN: Care Coordination & Outcomes

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

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management as part of the One Home/Home Solutions Utilization Management team, focused on post-acute care services.

You will use clinical nursing skills to determine care needs, communicate with providers and members, and deliver coordinated care while

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

• You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers
• You will complete request determinations within established processing time frames.

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management as part of the One Home/Home Solutions Utilization Management team, focused on post-acute care services.

You will use clinical nursing skills to determine care needs, communicate with providers and members, and deliver coordinated care while