Remote Utilization Management RN – Care Coordination Pro

Humana; Philadelphia (Philadelphia County); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation, and communications for medical services and benefit determinations. You will review information from physicians and care providers to make timely determinations and communicate with stakeholders to facilitate appropriate care.

This role supports post-acute services across SNF, home health, and DME, with a focus on delivering coordinated care for Humana members.

Qualifications

• RN license in state of residence
• >1 year RN experience in hospital/SNF/Home Health/acute care
• Passion for improving consumer experiences

Responsibilities

• Interpret and support coordination, documentation, and communication of medical services and benefit determinations using established nursing criteria.
• Make determinations based on information from providers and attending physicians within established processing time frames.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Deliver coordinated care for Humana members and ensure alignment with department strategies and goals.
• Understand department, segment, and organizational strategy and linkages to related areas.

Job description

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation, and communications for medical services and benefit determinations. You will review information from physicians and care providers to make timely determinations and communicate with stakeholders to facilitate appropriate care.

This role supports post-acute services across SNF, home health, and DME, with a focus on delivering coordinated care for Humana members.