Remote Utilization Management RN: Care Coordination Pro

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

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Holidays and leaves

Disability insurance

Life insurance

Bonus incentive plan

Job summary

Humana is seeking an Utilization Management Registered Nurse to interpret and support the coordination, documentation, and communication of medical services and benefit determinations for post-acute care services (SNF, Home Health, DME). You will report to the Manager of Utilization Management and be part of the One Home/Home Solutions Utilization Management team.

The role requires an active Compact RN license, >1 year of RN experience, and a passion for improving consumer experiences.

Qualifications

• Must hold Compact RN license in your state
• Over one year of clinical RN experience in hospital, SNF, home health, or acute care
• Must be passionate about improving consumer experiences
• Preferred: experience in utilization management or utilization review
• Preferred: knowledge of Milliman Care Guidelines or Interqual
• Preferred: experience in a remote, metrics-focused role
• Preferred: experience as an MDS Coordinator or discharge planner in an acute care setting
• Preferred: RN for a Medicare Certified Home Health agency
• Preferred: Health Plan or Medicare/Medicaid experience
• Preferred: call center or triage experience

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make 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, or other parties to facilitate care.
• 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 RN experience

Remote/work-from-home experience

Discharge planning

MDS/Medicare knowledge

Utilization management experience

Medicare/Medicaid experience

Call center/triage experience

Education

BSN or Bachelor's degree in a related field

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and support the coordination, documentation, and communication of medical services and benefit determinations for post-acute care services (SNF, Home Health, DME). You will report to the Manager of Utilization Management and be part of the One Home/Home Solutions Utilization Management team.

The role requires an active Compact RN license, >1 year of RN experience, and a passion for improving consumer experiences.