Remote Utilization Management RN - Care Coordinator

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

Benefits offered by this job

Bonus incentive plan

Medical, dental, vision benefits

401(k) retirement savings plan

Paid time off and holidays

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services for benefit determinations. You will use established criteria and collaborate with physicians to ensure timely reviews and appropriate care settings.

The role requires an RN license, 1+ year of clinical RN experience, and a passion for improving consumer experiences.

Qualifications

• Must hold Compact 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 determinations.
• Using established medical criteria, 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.
• Deliver coordinated care for our members and align with department and organizational strategy.

Skills

RN license

Clinical nursing experience

Utilization management experience

Remote work experience

Communication with providers andmembe

Education

BSN or bachelor's degree in a related field

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services for benefit determinations. You will use established criteria and collaborate with physicians to ensure timely reviews and appropriate care settings.

The role requires an RN license, 1+ year of clinical RN experience, and a passion for improving consumer experiences.