Remote Utilization Management RN — Care Coordinator

Humana; Ohio; A distancia; USD 71.000 - 98.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Bonus incentive plan

Remote work option

Descripción de la vacante

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care services including SNF, home health and DME.

You will determine based on established medical criteria, review information from clinicians, and complete determinations within set timeframes while engaging with providers and members to facilitate appropriate care.

Formación

• Must hold Compact RN license in your state of residence.
• At least 1 year of clinical RN experience in hospital, SNF, home health, or acute care setting.
• Passionate about improving consumer experiences.

Responsabilidades

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria based on physician information and care providers.
• Complete request determinations within established 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 goals and how they link to related areas.

Conocimientos

Clinical nursing experience

Utilization management experience

Remote/work from home experience

Provider communication

Educación

Compact RN license

BSN or bachelor’s degree

Herramientas

Milliman Care Guidelines

InterQual

Descripción del empleo

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care services including SNF, home health and DME.

You will determine based on established medical criteria, review information from clinicians, and complete determinations within set timeframes while engaging with providers and members to facilitate appropriate care.