Remote Utilization Management RN | Care Coordination Pro

Humana; Maine; À distance; USD 71 000 - 98 000; Plein temps

Avantages offerts par ce poste

Medical benefits

401(k) retirement plan

Bonus incentive plan

Résumé du poste

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. You will work remotely, reporting to the Manager of Utilization Management and serve on the One Home/Home Solutions team handling post-acute care services.

You will apply established criteria to make determinations, communicate with providers and members, and help ensure the right level of care in the right setting,

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of RN clinical experience in hospital, SNF, Home Health or acute care.
• Experience in utilization management / utilization review for a health plan or acute care setting.
• Knowledge of Milliman Care Guidelines or InterQual.
• Experience in a fully remote, metrics-focused role.
• Experience as an MDS Coordinator or discharge planner in an acute care setting.
• Experience as an RN for a Medicare Certified Home Health agency.
• Health Plan or Medicare/Medicaid experience.
• Call center or triage experience.
• BSN or bachelor's degree in a related field.

Responsabilités

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria based on info from physician and care providers.
• Communicate with providers, members or other parties to facilitate care and treatment.
• Help deliver coordinated care for our members.

Connaissances

RN license

Remote work experience

Healthcare experience

Utilization management

Medicare/Medicaid knowledge

MDS Coordinator / discharge planner

Call center / triage experience

Formation

BSN or bachelor's degree

Description du poste

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. You will work remotely, reporting to the Manager of Utilization Management and serve on the One Home/Home Solutions team handling post-acute care services.

You will apply established criteria to make determinations, communicate with providers and members, and help ensure the right level of care in the right setting,