Remote Utilization Management RN – Post-Acute Care

Humana

Montgomery (AL)

Remote

USD 71,000 - 98,000

Full time

5 days ago

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Benefits offered by this job

Bonus incentive plan

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Parental leave

Disability insurance

Life insurance

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 report to the Manager of Utilization Management on the One Home/Home Solutions team, focusing on post-acute care including SNF, Home Health and DME.

The role requires an active RN license in your state, 1+ year of clinical experience, and familiarity with Milliman Care Guidelines or Interqual.

Qualifications

Active RN license in state of residence.
1+ year of clinical experience in hospital, SNF, Home Health, or acute care.
Experience in utilization management/utilization review.

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 other providers.
Communicate with providers, members, or other parties to facilitate care and treatment.
Deliver coordinated care for members.