Remote Utilization Management RN for Care Coordination

Humana; New Jersey; 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 and holidays

Job summary

Humana's Utilization Management Registered Nurse role focuses on coordinating and documenting medical services and benefit determinations for post-acute care (SNF, Home Health, DME). You will interpret clinical nursing data and communicate with providers to ensure appropriate care levels.

The UM RN collaborates with the Manager of Utilization Management and the One Home/Home Solutions team, applying criteria such as Milliman InterQual to support timely decisions while aligning with

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical RN experience in hospital/SNF/home health/acute care.
• Passionate about improving consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Make determinations based on information from physician and care providers using established criteria.
• Complete request determinations within established processing time frames.

Skills

RN license

RN clinical experience

Communication with providers

Remote work experience

Education

BSN or related degree

Tools

Milliman Care Guidelines

InterQual

Job description

Humana's Utilization Management Registered Nurse role focuses on coordinating and documenting medical services and benefit determinations for post-acute care (SNF, Home Health, DME). You will interpret clinical nursing data and communicate with providers to ensure appropriate care levels.

The UM RN collaborates with the Manager of Utilization Management and the One Home/Home Solutions team, applying criteria such as Milliman InterQual to support timely decisions while aligning with