Remote Utilization Management RN - Elevate Care

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

Benefits offered by this job

Bonus incentive plan

Job summary

Humana is seeking an 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 support SNF, home health, and DME post-acute care services.

The role requires an active Compact RN license, 1+ year of RN experience in hospital/SNF/home health/acute care, and a passion for improving consumer experiences.

Qualifications

• Current Compact RN license in your state of residence.
• 1+ year of clinical RN experience in hospital, SNF, home health, or acute care setting.
• Passionate about contributing to an organization focused on improving consumer experiences.
• Prior utilization management experience or UM for a health plan is preferred.
• Experience with medical necessity criteria (e.g., Milliman Care Guidelines or InterQual) is preferred.

Responsibilities

• Use clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations based on information provided by the attending physician and other care providers using established criteria.
• 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

Compact RN license (RN)

Clinical nursing experience

Patient-focused care

Remote work experience

Call center or triage experience

BSN or related degree

Education

Bachelor's degree in Nursing (BSN) or related field

Job description

Humana is seeking an 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 support SNF, home health, and DME post-acute care services.

The role requires an active Compact RN license, 1+ year of RN experience in hospital/SNF/home health/acute care, and a passion for improving consumer experiences.