Remote Utilization Management RN – Post-Acute Care

Humana; Colorado; Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. You will determine based on established criteria using information from physicians and care providers, and communicate with providers and members to facilitate care.

The role emphasizes remote work, prior utilization management experience, and a BSN or related degree, with potential travel for training or meetings.

Qualifications

• Active Compact RN license in state of residence.
• Experience in hospital, SNF, Home Health, or acute care.
• Familiarity with Milliman Care Guidelines or InterQual.
• Experience in utilization management or utilization review.
• Remote, metrics-focused work experience.
• RN with Medicare/Medicaid exposure.
• Experience in home health-/SNF-/acute-care settings.

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 others to facilitate care and treatment.
• Help deliver coordinated care for members.

Skills

RN license

Clinical nursing

Utilization management

Care criteria knowledge

Remote work experience

MDS coordination/ discharge planning

Medicare/Medicaid experience

Call center / triage

BSN or related degree

Education

BSN or bachelor's degree

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. You will determine based on established criteria using information from physicians and care providers, and communicate with providers and members to facilitate care.

The role emphasizes remote work, prior utilization management experience, and a BSN or related degree, with potential travel for training or meetings.