Remote Utilization Management RN – Post-Acute Care

Humana; Helena (MT); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking a Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care across SNF, Home Health, and DME. This remote role reports to the Manager of Utilization Management and supports the One Home/Home Solutions team.

Responsibilities include applying clinical criteria, making determinations with physician input, communicating with providers and members, and advancing coordinated care.

Qualifications

• RN license in your state of residence.
• Greater than one year of clinical RN experience in hospital, SNF, Home Health or acute care.
• Experience in utilization management/utilization review.
• Knowledge of Milliman Care Guidelines or Interqual.
• Remote, metrics-focused work experience.
• MDS Coordinator or discharge planner experience is a plus.
• Medicare/Medicaid experience.

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations.
• Use established medical criteria to make determinations based on physician information.
• Communicate with providers, members or other parties to facilitate care and treatment.
• Help deliver coordinated care for our members.

Skills

RN license

Clinical experience

Utilization management

Remote work

MDS coordinator

Medicare/Medicaid experience

Call center

Education

BSN or bachelor's degree

Job description

Humana is seeking a Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care across SNF, Home Health, and DME. This remote role reports to the Manager of Utilization Management and supports the One Home/Home Solutions team.

Responsibilities include applying clinical criteria, making determinations with physician input, communicating with providers and members, and advancing coordinated care.