About the role
Humana is hiring a full-time remote Utilization Management RN for its One Home / Home Solutions team, which handles post-acute services such as skilled nursing facility stays, home health, and durable medical equipment. You'll apply established medical criteria to make timely determinations and talk with providers and members. A compact RN license in your state of residence is required, and Florida and Texas residents are eligible.
Responsibilities
- Use clinical nursing skills to interpret and support the documentation, coordination, and communication of medical services and benefit determinations
- Make determinations using established medical criteria and information from attending physicians and other care providers
- Complete requests within set processing time frames
- Communicate with providers, members, and other parties to facilitate care and treatment
- Help deliver coordinated care for members across post-acute settings (SNF, home health, DME)
Requirements
- Compact Registered Nurse (RN) license in your state of residence
- More than 1 year of clinical RN experience in a hospital, SNF, home health, or acute care setting
- Preferred: UM/UR experience in a health plan or acute care setting; working knowledge of MCG or InterQual criteria
- Preferred: experience in a fully remote, metrics-driven role; MDS coordinator, discharge planning, or Medicare-certified home health RN background; Medicare/Medicaid experience; BSN
- Home internet of at least 25 Mbps down / 10 Mbps up and a dedicated, HIPAA-appropriate workspace
- Occasional travel to a Humana office for training or meetings may be required
- Florida-based hires are subject to Florida Level 2 background screening
What we offer
- Eligible for a bonus incentive plan
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Paid time off, company and personal holidays, paid parental and caregiver leave
- Short- and long-term disability and life insurance
- Telephone equipment provided for remote work