Remote Utilization Management RN – Case Coordination

Humana; United (LA); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Job summary

Humana is seeking a Utilization Management Nurse to support the coordination, documentation and communication of medical services and benefit determinations. This role requires clinical nursing skills and independent decision-making.

You will interpret criteria and policies, coordinate with providers and members to ensure appropriate care, and work remotely within the eastern or central time zones.

Qualifications

• Licensed Registered Nurse (RN) with no disciplinary action.
• Bachelor's degree
• 3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
• Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Ability to work independently under general instructions and with a team
• MCG/InterQual experience
• Previous experience in utilization management
• Health Plan experience
• Previous Medicare/Medicaid experience
• Call center or triage experience

Responsibilities

• Coordinate and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care or services.
• Follows established guidelines/procedures and works both independently and within a team.

Job description

Humana is seeking a Utilization Management Nurse to support the coordination, documentation and communication of medical services and benefit determinations. This role requires clinical nursing skills and independent decision-making.

You will interpret criteria and policies, coordinate with providers and members to ensure appropriate care, and work remotely within the eastern or central time zones.