Remote Utilization Management RN - Care Coordination Pro

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

Benefits offered by this job

Bonus incentive plan

Remote-friendly

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team.

This team manages post-acute care services including SNF, Home Health, and DME. The role focuses on ensuring members receive the appropriate level of care in the most appropriate

Qualifications

• Must hold Compact RN license in your state.
• 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, you will 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.

Skills

Clinical nursing

Communication with providers

Adaptability

Education

Compact RN license

Tools

Milliman Care Guidelines

InterQual

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team.

This team manages post-acute care services including SNF, Home Health, and DME. The role focuses on ensuring members receive the appropriate level of care in the most appropriate