Remote Utilization Management RN: Elevate Care Coordination

Humana; South Dakota; Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking a 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 join the One Home/Home Solutions Utilization Management team focusing on post-acute care services including SNF, Home Health, and DME.

You will use clinical nursing skills, base determinations on criteria, complete requests within processing timeframes, and

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as a 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.

Skills

RN license

Clinical nursing experience

Remote work experience

Job description

Humana is seeking a 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 join the One Home/Home Solutions Utilization Management team focusing on post-acute care services including SNF, Home Health, and DME.

You will use clinical nursing skills, base determinations on criteria, complete requests within processing timeframes, and