Remote Utilization Management RN – Medicare/Health Plan

Humana; Portland (ME); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical benefits

Dental and vision

401(k) plan

Paid time off

Job summary

Humana is seeking a Utilization Management Registered Nurse for a fully remote role supporting post-acute care services. You will interpret clinical information to determine medical necessity, coordinate communications with providers and members, and help deliver coordinated care across SNF, home health and DME settings.

Requirements include a compact RN license, 1+ year RN experience, utilization management exposure, and a BSN or higher degree.

Qualifications

• Active Compact RN license
• 1+ year RN experience in hospital/SNF/home health
• Experience in utilization management/UD for health plan
• Experience with post-acute care coordination
• MDS coordinator or discharge planning background
• Medicare/Medicaid experience beneficial
• Call center/triage experience helpful
• BSN or related bachelor’s degree

Responsibilities

• Interpret and support determinations using established medical criteria
• Coordinate, document and communicate medical services and benefit determinations
• Communicate with providers, members and other parties to facilitate care
• Help deliver coordinated care for members in post-acute settings

Skills

RN license

Utilization management

InterQual/MCG

Remote work exp

MDS/discharge planning

Medicare/Medicaid exp

Call center/triage

BSN

Education

BSN

Job description

Humana is seeking a Utilization Management Registered Nurse for a fully remote role supporting post-acute care services. You will interpret clinical information to determine medical necessity, coordinate communications with providers and members, and help deliver coordinated care across SNF, home health and DME settings.

Requirements include a compact RN license, 1+ year RN experience, utilization management exposure, and a BSN or higher degree.