Remote Utilization Management RN — Care Coordination Pro

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

Benefits offered by this job

Health benefits

401(k) plan

Paid time off

Job summary

Humana is seeking a qualified Utilization Management Registered Nurse to join the One Home/Home Solutions UM team. This remote role focuses on interpreting medical criteria, coordinating documentation, and communicating determinations for post-acute care services including SNF, Home Health, and DME.

You will report to the Manager of Utilization Management, support care coordination, and strive to ensure members receive appropriate care in the right setting.

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

• 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

Patient advocacy

Tools

Milliman Care Guidelines

InterQual

Job description

Humana is seeking a qualified Utilization Management Registered Nurse to join the One Home/Home Solutions UM team. This remote role focuses on interpreting medical criteria, coordinating documentation, and communicating determinations for post-acute care services including SNF, Home Health, and DME.

You will report to the Manager of Utilization Management, support care coordination, and strive to ensure members receive appropriate care in the right setting.