Remote Utilization Management RN – Post-Acute Care

Humana Inc; Boise (ID); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. invites a qualified Utilization Management Registered Nurse to interpret and support coordination, documentation and communications for medical services and benefit determinations.

You will report to the Manager of Utilization Management within the One Home/Home Solutions Utilization Management team dedicated to post-acute care services. Required qualifications include an active RN license in your state, over one year of clinical RN experience, and a passion for improving consumer

Qualifications

• Must hold Compact Registered Nurse (RN) license in your state of residence.
• Greater than one year of clinical experience as a RN 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 determinations.
• Make determinations based on established medical criteria from 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 our members.
• Understand department, segment and organizational strategy and operating goals.

Skills

RN license

Clinical nursing

Remote work

Education

BSN or bachelor's degree in related field

Job description

Humana Inc. invites a qualified Utilization Management Registered Nurse to interpret and support coordination, documentation and communications for medical services and benefit determinations.

You will report to the Manager of Utilization Management within the One Home/Home Solutions Utilization Management team dedicated to post-acute care services. Required qualifications include an active RN license in your state, over one year of clinical RN experience, and a passion for improving consumer