Remote Utilization Management RN — Care Coordinator

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

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement plan

Paid time off

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You will report to the Manager of Utilization Management and join the One Home/Home Solutions Utilization Management team, which manages post-acute care services including SNF, Home Health, and DME.

The role involves applying clinical criteria to determine medical necessity, completing determinations within timeframes,

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical experience as an 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 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, including their linkages to related areas.

Skills

RN license

Clinical nursing

Education

BSN or bachelor’s degree

Tools

Milliman Care Guidelines

Interqual

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You will report to the Manager of Utilization Management and join the One Home/Home Solutions Utilization Management team, which manages post-acute care services including SNF, Home Health, and DME.

The role involves applying clinical criteria to determine medical necessity, completing determinations within timeframes,