Remote Utilization Management RN for Care Coordination

Humana Inc; Lincoln (NE); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations for post-acute care settings.

You will make determinations using established criteria, collaborate with providers and members, and ensure timely processing of reviews. This full-time, remote role may involve travel to Humana offices for training or meetings.

Qualifications

• Must hold Compact RN license in your state of residence.
• Over 1 year of clinical RN experience in hospital/SNF/home health/acute care.
• Passionate about contributing to an organization focused on improving consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations using established medical criteria based on information from 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.
• Help deliver coordinated care for our members.
• Understand department, segment, and organizational strategy and operating goals.

Skills

RN license

Clinical nursing

Communication

Utilization management

Education

BSN or related bachelor's degree

Tools

Milliman Care Guidelines

InterQual

Job description

Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations for post-acute care settings.

You will make determinations using established criteria, collaborate with providers and members, and ensure timely processing of reviews. This full-time, remote role may involve travel to Humana offices for training or meetings.