Remote Utilization Management RN - Impactful Care Decisions

Humana; Colorado Springs (CO); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is hiring a Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit determinations. You will work with the One Home/Home Solutions Utilization Management team to ensure members receive appropriate care in the right setting.

The role requires an RN license, clinical experience, and a focus on consumer experiences. Remote work is supported with travel as needed.

Qualifications

• Must hold Compact RN license in your state of residence.
• Greater than one year of clinical RN experience in a hospital, SNF, Home Health, or acute care setting.
• Must be passionate about contributing to an organization focused on improving consumer experiences.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit administration determinations.
• Make determinations using established medical criteria based on information from attending physicians and care providers.
• Complete request determinations within established processing time frames.
• Communicate with providers, members or other parties to facilitate care and treatment.
• Help deliver coordinated care for Humana's members.
• Understand department, segment, and organizational strategy and goals and linkages to related areas.

Skills

RN license

Clinical RN experience

Communication with providers

Remote work experience

Healthcare knowledge

Education

Nursing degree

BSN

Job description

Humana is hiring a Utilization Management Registered Nurse to interpret and support the coordination, documentation and communication of medical services and benefit determinations. You will work with the One Home/Home Solutions Utilization Management team to ensure members receive appropriate care in the right setting.

The role requires an RN license, clinical experience, and a focus on consumer experiences. Remote work is supported with travel as needed.