Remote Utilization Nurse, LTSS/HCBS Authorizations

Humana Inc; Illinois; Hybrid; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

Bonus incentive plan

Job summary

Humana Inc. is seeking a Remote Utilization Management Nurse to review LTSS and HCBS requests for Illinois Medicaid members, making coverage determinations and coordinating care with providers and inter-disciplinary teams.

The role requires IL RN licensure (or eligibility), 1+ year UM/LTSS experience, and strong MS Word/Outlook/Excel skills. Schedule is Mon-Fri 8am-5pm CST with travel up to 25% for in-state meetings.

Qualifications

• Licensed Registered Nurse in Illinois or eligible before start date.
• 1+ year of utilization management/LTSS service authorization experience.
• 2+ years of clinical experience in acute care, rehab, or Medicaid managed care.

Responsibilities

• Review LTSS and HCBS requests and authorize coverage.
• Coordinate with providers, members and interdisciplinary teams.
• Make evidence-based coverage determinations in line with state and contract requirements.
• Communicate decisions and ensure timely authorization creation.

Skills

RN license

UM LTSS experience

Clinical experience

MS Word/Excel

Education

Bachelor's degree in nursing or related field

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Job description

Humana Inc. is seeking a Remote Utilization Management Nurse to review LTSS and HCBS requests for Illinois Medicaid members, making coverage determinations and coordinating care with providers and inter-disciplinary teams.

The role requires IL RN licensure (or eligibility), 1+ year UM/LTSS experience, and strong MS Word/Outlook/Excel skills. Schedule is Mon-Fri 8am-5pm CST with travel up to 25% for in-state meetings.