Remote Utilization Management RN for Care Optimization

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

Job summary

Humana is seeking a nurse to support utilization management. The Utilization Management Nurse 2 coordinates, documents and communicates medical determinations, drawing on diverse clinical nursing skills.

The role requires independent judgment and collaboration with internal and external parties to improve patient outcomes. Qualified candidates will have an Associate Degree in Nursing, an active RN license in a compact state, and 3+ years of clinical experience including geriatric care, plus

Qualifications

• Minimum of Associate Degree in nursing.
• Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
• Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
• Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population.
• Effective telephonic and virtual communication skills.
• Comprehensive knowledge of Microsoft Word, Outlook and Excel.
• Ability to work independently under general instructions and within a team.

Responsibilities

• Coordinate, document and communicate medical services and/or benefit determinations.
• Provide clinical nursing support to ensure patient outcomes.

Skills

RN license

Compact state license

Clinical experience

Telephonic communication

MS Word

Outlook

Excel

Independent working

Education

Associate Degree in Nursing

Bachelor’s degree (preferred)

Tools

Microsoft Word

Outlook

Excel

Job description

Humana is seeking a nurse to support utilization management. The Utilization Management Nurse 2 coordinates, documents and communicates medical determinations, drawing on diverse clinical nursing skills.

The role requires independent judgment and collaboration with internal and external parties to improve patient outcomes. Qualified candidates will have an Associate Degree in Nursing, an active RN license in a compact state, and 3+ years of clinical experience including geriatric care, plus