Remote Utilization Management RN - Home Health Focus

Humana, Inc.; Kentucky; Hybrid; 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

Short-term and long-term disability

Life insurance

Job summary

Humana, Inc. is seeking an Utilization Management Nurse 2 to coordinate, document, and communicate medical services and benefit determinations for our members.

You will interpret clinical information to support recommendations and care coordination, and collaborate with internal and external parties to ensure fully coordinated care for each member. This is a remote role with standard business hours and occasional travel for training.

Qualifications

• Minimum of Associate Degree in nursing and active RN license in a compact state.
• Three or more years of progressive clinical experience including direct patient care.
• Strong telephonic and virtual communication skills; ability to navigate multiple systems.
• Ability to work independently under general instructions and within a team.
• Preferred experience in home health or utilization management.

Responsibilities

• Coordinate, document, and communicate medical services and benefit determinations.
• Interpret clinical information to support recommendations and care coordination.
• Collaborate with internal and external parties to ensure fully coordinated care for members.
• Utilize multiple systems to manage cases and maintain PHI/HIPAA compliance.

Skills

Nursing clinical skills

Analytical skills

Telephonic communication

Virtual communication

Independent judgment

Collaboration

Time management

Education

Associate Degree in Nursing

RN licensure in compact state

Bachelor’s degree preferred

Tools

Microsoft Word

Outlook

Excel

Job description

Humana, Inc. is seeking an Utilization Management Nurse 2 to coordinate, document, and communicate medical services and benefit determinations for our members.

You will interpret clinical information to support recommendations and care coordination, and collaborate with internal and external parties to ensure fully coordinated care for each member. This is a remote role with standard business hours and occasional travel for training.