Remote Utilization Management RN – Post-Acute Care

Humana; Sioux Falls (SD); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking a Utilization Management Registered Nurse who uses clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit determinations. This remote role focuses on post-acute care services including SNF, Home Health and DME, reporting to the Manager of Utilization Management.

You will review requests using established criteria, complete determinations within processing timeframes, and communicate with providers and

Qualifications

• RN license in the state of residence
• Greater than one year of clinical RN experience in hospital, SNF, Home Health, or acute care setting
• Passionate about contributing to improved consumer experiences

Responsibilities

• Interpret and support coordination, documentation and communication of medical services and benefit determinations
• Complete request determinations within established processing time frames
• Communicate with providers, members, or other parties to facilitate care and treatment
• Deliver coordinated care for our members
• Understand department, segment, and organizational strategy and operating goals

Skills

RN license

clinical RN experience

patient care coordination

Education

BSN or bachelor’s degree

Job description

Humana is seeking a Utilization Management Registered Nurse who uses clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit determinations. This remote role focuses on post-acute care services including SNF, Home Health and DME, reporting to the Manager of Utilization Management.

You will review requests using established criteria, complete determinations within processing timeframes, and communicate with providers and