Remote Utilization Management RN – Care Delivery Optimizer

Humana Inc; Montpelier (VT); Remote; USD 71,000 - 98,000; Full time

Job summary

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

You will report to the Manager of Utilization Management and work on a remote team focused on delivering appropriate care in the right setting, with standard processing timelines and close collaboration with providers, members and care teams.

Qualifications

• Must hold Compact Registered Nurse (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

• You will 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
• You will complete request determinations within established processing time frames.
• You will communicate with providers, members, or other parties to facilitate care and treatment.
• You will help deliver coordinated care for our members
• You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.

Skills

RN license

Clinical RN experience

Patient-focused

Job description

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

You will report to the Manager of Utilization Management and work on a remote team focused on delivering appropriate care in the right setting, with standard processing timelines and close collaboration with providers, members and care teams.