Remote Utilization Management RN for Post-Acute Care

Humana; Charleston (WV); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support the coordination, documentation, and communication of medical services and benefit determinations. You will work remotely, report to the Manager of Utilization Management, and contribute to post-acute care management including SNF, home health, and DME.

The role requires an RN license in your state of residence (compact), 1+ year RN experience in acute or post-acute settings, and familiarity with utilization

Qualifications

• Must hold Compact RN license in your state of residence.
• >1 year clinical RN experience in hospital/SNF/home health/acute care.
• Experience in utilization management/utilization review for a health plan or acute care setting.
• Basic knowledge of Milliman Care Guidelines or InterQual.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit administration determinations.
• Make determinations based on information from attending physician and other care providers using established criteria.
• Communicate with providers, members, or other parties to facilitate care and treatment.
• Deliver coordinated care for our members.

Skills

RN license

Utilization review

Remote work experience

Medicare/Medicaid experience

Milliman/InterQual knowledge

Education

BSN or related field

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support the coordination, documentation, and communication of medical services and benefit determinations. You will work remotely, report to the Manager of Utilization Management, and contribute to post-acute care management including SNF, home health, and DME.

The role requires an RN license in your state of residence (compact), 1+ year RN experience in acute or post-acute settings, and familiarity with utilization