Remote Utilization Management RN — Home Health & DME

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

Benefits offered by this job

Bonus incentive plan

Internet stipend for remote workers in

Travel for training

Job summary

The Utilization Management Registered Nurse at Humana interprets clinical data to support coordination, documentation and communication of medical services and benefit determinations for post-acute care. You will collaborate with physicians, providers and care teams to ensure appropriate care in the most appropriate setting.

Remote work is supported; you will use established medical criteria such as Milliman Care Guidelines or Interqual and may travel occasionally for training or meetings.

Qualifications

• Must hold Compact RN license in state of residence.
• >1 year of clinical RN experience in hospital, SNF, Home Health or acute care.
• Previous utilization management/UR experience in a health plan or acute care setting.
• Experience working in a remote, metrics-focused role.

Responsibilities

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

Skills

RN license

Clinical nursing experience

Utilization management experience

MDS coordinator / discharge planner

Medicare/Medicaid experience

Education

BSN or Bachelor's degree in a related field

Tools

Milliman Care Guidelines

Interqual

Job description

The Utilization Management Registered Nurse at Humana interprets clinical data to support coordination, documentation and communication of medical services and benefit determinations for post-acute care. You will collaborate with physicians, providers and care teams to ensure appropriate care in the most appropriate setting.

Remote work is supported; you will use established medical criteria such as Milliman Care Guidelines or Interqual and may travel occasionally for training or meetings.