Remote Utilization Management RN for Home Health & DME

Humana; Florida; A distancia; USD 71.000 - 98.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Bonus incentive plan

Competitive benefits

Descripción de la vacante

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. This role reports to the Manager of Utilization Management within the One Home/Home Solutions Utilization Management team, focused on post-acute care including SNF, Home Health and DME.

You will use clinical nursing skills to determine medical necessity using Milliman or Interqual criteria, and communicate with

Formación

• Must hold Compact 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.
• Previous experience in utilization management/utilization review for a health plan or acute care setting
• Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
• Experience working in a fully remote, metrics-focused role
• Experience as an MDS Coordinator or discharge planner in an acute care setting
• Experience as an RN for a Medicare Certified Home Health agency
• Health Plan or Medicare / Medicaid Experience
• Call center or triage experience
• BSN or bachelor's degree in a related field

Responsabilidades

• Interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Help deliver coordinated care for our members.

Conocimientos

RN license (Compact)

Remote work experience

Call center/triage experience

Medicare/Medicaid experience

Home Health/Discharge planning

MDS Coordinator/Discharge planning

Educación

BSN or bachelor's degree in a related field

Descripción del empleo

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. This role reports to the Manager of Utilization Management within the One Home/Home Solutions Utilization Management team, focused on post-acute care including SNF, Home Health and DME.

You will use clinical nursing skills to determine medical necessity using Milliman or Interqual criteria, and communicate with