Remote Utilization Management RN – Impactful Care

Humana; Bastrop (LA); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement plan

Paid time off

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support medical service coordination, documentation and benefit determinations. You will report to the Manager of Utilization Management and support post-acute care services, including SNF, Home Health, and DME.

Key duties include applying clinical criteria to make determinations, collaborating with physicians and providers, and ensuring timely processing of reviews.

Qualifications

• Must hold a Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as an RN in hospital, SNF, Home Health, or acute care setting.
• Preferred: experience in utilization management or utilization review.

Responsibilities

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

Skills

RN license

Clinical nursing experience

Remote work experience

Patient care coordination

Education

BSN or Bachelor's degree

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support medical service coordination, documentation and benefit determinations. You will report to the Manager of Utilization Management and support post-acute care services, including SNF, Home Health, and DME.

Key duties include applying clinical criteria to make determinations, collaborating with physicians and providers, and ensuring timely processing of reviews.