Remote Utilization Management RN | Medicare & Home Health

Humana; Indianapolis (IN); Teletrabalho; USD 71 000 - 98 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, dental and vision benefits

401(k) retirement plan

Paid time off and holidays

Resumo da oferta

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. You will work with physicians and care teams to ensure appropriate care levels in the most suitable setting.

Responsibilities include making determinations based on established criteria, communicating with providers and members, and delivering coordinated care.

Qualificações

• RN license in state of residence.
• Over 1 year of clinical RN experience in hospital, SNF, home health or acute care.
• Experience in utilization management / utilization review for a health plan or acute care setting.
• Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
• Experience in a fully remote, metrics-focused role.
• Experience as an MDS Coordinator or discharge planner in an acute care setting.
• Experience as an RN for a Medicare Certified Home Health agency.
• Health Plan or Medicare/Medicaid experience.
• Call center or triage experience.

Responsabilidades

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

Conhecimentos

RN license

Clinical nursing experience

Remote work experience

Call center / triage experience

Medicare/Medicaid experience

MDS coordinator or discharge planner

Knowledge of medical necessitycriteria

Formação académica

BSN or Bachelor's degree in a related field

Descrição da oferta de emprego

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. You will work with physicians and care teams to ensure appropriate care levels in the most suitable setting.

Responsibilities include making determinations based on established criteria, communicating with providers and members, and delivering coordinated care.