Remote Utilization Management RN – Care Coordination Pro

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

Benefits offered by this job

Bonus incentive plan

Job summary

Humana is seeking an 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 and join the One Home/Home Solutions Utilization Management team focused on post-acute care services including SNF, Home Health and DME.

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

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical RN experience in a hospital, SNF, Home Health, or acute care setting.
• Must be passionate about contributing to an organization focused on improving consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit administration determinations.
• Make determinations based on established medical criteria using 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 and treatment.
• Help deliver coordinated care for our members.
• Understand department, segment, and organizational strategy and operating goals.

Skills

RN license

Clinical nursing

Provider communication

Remote work experience

Education

BSN or bachelor’s degree

Tools

HIPAA knowledge

Job description

Humana is seeking an 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 and join the One Home/Home Solutions Utilization Management team focused on post-acute care services including SNF, Home Health and DME.

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